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Mean initial cerebral saturation during advanced life support in out-of hospital cardiac arrest patients, predictor of survival?
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Mean initial cerebral saturation during advanced life support in out-of hospital cardiac arrest patients, predictor of survival?
No full textNon-invasive monitoring of cerebral perfusion during Transcatheter Aortic Valve Implantation procedure
No full textNIRS cerebral oxygenation monitoring during transcutaneous aortic valve implant (TAVI)
No full textIntroduction: Most recent attention in interventional cardiology is directed towards treatment of valvular heart disease. In high risk pts, transcutaneous aortic valve implantation (TAVI) offers a therapeutic solution. Near Infrared Spectroscopy (NIRS) has been introduced as a useful non-invasive cerebral monitoring technique assessing cerebral oxygenation. During TAVI procedure, transient cardiac standstill by rapid ventricular pacing (RVP) is induced to minimize cardiac motion. In most cases, this hemodynamic deficit is well tolerated, due to the brief duration of RVP. But as far as today no data are available on cerebral oxygenation during these critical periods of RVP.
Methods: We report on 10 consecutive pts (>75yrs, major comorbidities) suffering from severe aortic stenosis. Bilateral ForeSight sensors were applied after induction of anesthesia. We studied the changes in cerebral oxygenation (SctO2 monitoring) occurred during these RVP periods.
Results: In all pts, procedure was technically successful. Mean SctO2 before RVP was 67% (59-71%) with immediate decrease during RVP to m54% (37-70%). In 7 pts, RVP resulted in SctO2 decreases below 55% (m44%; range 37-52%), lasting for m20 min (14sec-87 min). Systolic blood pressure before RVP was m135mmHg (95-165mmHg) and decreased to m74mmHg (112-42mmHg) during RVP. In 6 pts, RVP resulted in systolic blood pressure below 90mmHg, immediately countered by vasoactive drugs. In 2 pts, extensive hypotension persisted despite vasoactive support and CPR had to be initiated. In 1 pt, SctO2 values remained below 55% for 87 min and pt was declared brain dead 48 h later.
Conclusion: Transcutaneous cardiac interventions, with transient cardiac standstill, can induce longlasting inadequacy of cerebral perfusion, despite immediate restoration of normal hemodynamics. Future strategies should focus on optimalizing cerebral oxygenation before RVP
Noninvasive cerebral oxygenation monitoring during rapid ventricular pacing in transcutaneous aortic valve implant
No full textIntroduction: Most recent attention in interventional cardiology is now directed towards treatment of valvular heart disease. In patients with high-risk cardiac surgery, transcutaneous aortic valve implantation (TAVI) could offer a therapeutic solution. Near-infrared spectroscopy (NIRS) has been introduced as a useful noninvasive cerebral monitoring technique assessing cerebral oxygenation. As of today, no reports have been published on the use of any NIRS technology during TAVI procedures. During valve prosthesis implantation, a cardiac standstill by rapid ventricular pacing (RVP) is induced to minimize cardiac motion. While RVP is advantageous for valve positioning, a combination of rapid heart rate and ventricular hypertrophy can induce a complete loss of cardiac output. In most cases, this hemodynamic deficit is well tolerated, due to the brief duration of RVP. But as of today no data are available on cerebral oxygenation during these critical periods of RVP. Methods: We report on 10 consecutive patients (>75 years, major comorbidities) suffering from severe aortic stenosis. Bilateral ForeSight sensors were applied after induction of anesthesia. We were especially interested if any change in cerebral oxygenation (SctO2 monitoring) occurred during these RVP periods. Results: In all patients, the procedure was technically successfully performed. Mean SctO2 before RVP was 67% (59 to 71%) and immediately decreased during RVP to mean 54% (37 to 70%). In seven patients, RVP resulted in SctO2 decreases below 55% (mean 44%; range 37 to 52%). These decreases lasted for mean 20 minutes (14 seconds to 87 minutes). Systolic blood pressure before RVP was mean 135 mmHg (95 to 165 mmHg) and decreased to mean 74 mmHg (112 to 42 mmHg) during RVP. In six patients, RVP resulted in a decrease in systolic blood pressure below 90 mmHg, which was immediately countered by vasoactive drugs (adrenaline). In two patients, extensive hypotension persisted despite vasoactive support and CPR had to be initiated. In one patient, SctO2 values remained below 55% for 87 minutes and the patient was declared brain dead 48 hours later. Conclusion: Transcutaneous cardiac interventions, especially those with transient cardiac standstill, can induce longlasting intraprocedural inadequacy of cerebral perfusion, despite immediate restoration of normal blood pressure. Future strategies should therefore be focused on optimalizing cerebral oxygenation before RVP
Accuracy of continuous thermodilution cardiac output by pulmonary artery catheter during therapeutic hypothermia in post-cardiac arrest patients
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