Mixed venous oximetry during automatic implantable cardioverter-defibrillator placement.
Mixed venous oxygen saturation (SvO2) monitoring was used to assess tissue and circulatory recovery following induced ventricular tachycardia or fibrillation in 17 patients undergoing surgery for automatic implantable cardioverter-defibrillator (AICD) placement. Return of systemic arterial pressure conventionally determines adequate recovery. The duration of circulatory arrest during defibrillator threshold (DFT) testing, measured from the moment of absent phasic pressure at the radial artery until its return, was 18 +/- 8 seconds (mean +/- SD, n = 118 episodes). The absolute decrease in SvO2 from baseline to nadir for these 118 episodes was 14% +/- 6% absolute, and correlated well with the duration of circulatory arrest (r = 0.757, P = 0.0001). The time from onset of phasic arterial blood pressure to the nadir of SvO2, available for 46 episodes, was 28 +/- 14 seconds, and did not correlate with the duration of arrest. The time from onset of phasic pressure to the return of SvO2 to within 1% (absolute) of baseline saturation, available for 84 episodes, was 52 +/- 32 seconds and, in the aggregate, correlated poorly (r = 0.401) with duration of arrest. Simultaneous recording of arterial pressure and SvO2 (n = 41) showed that arterial recovery (6 +/- 3 seconds) occurred long before SvO2 recovery (48 +/- 16 seconds, P = 0.0001). The authors interpret these data as showing that mixed venous oximetry, compared to arterial blood pressure, provides a more sensitive indicator of tissue recovery following periods of circulatory arrest during DFT testing of AICDs.
Van Riper
D F
DF
Department of Anesthesiology, Hahnemann University School of Medicine, Philadelphia, PA 19102-1192.
Horrow
J C
JC
Kutalek
S P
SP
McCormick
D
D
Goldman
S M
SM
D001145:Arrhythmias, Cardiac / Q000097:blood* / Q000503:physiopathology / Q000601:surgery; D002407:Catheterization, Swan-Ganz; D002985:Clinical Protocols; D004056:Differential Threshold; D004554:Electric Countershock; D005069:Evaluation Studies as Topic; D006324:Heart Arrest, Induced; D006801:Humans; D016343:Monitoring, Intraoperative / Q000379:methods / Q000592:standards*; D010092:Oximetry / Q000379:methods / Q000592:standards*; D019736:Prostheses and Implants; D013997:Time Factors