Combined continuous monitoring of systemic and cerebral oxygen metabolism after cardiac arrest.
Cerebral oxygenation was assessed in 8 patients in cardiac arrest during the 24 h after resuscitation, by continuous fiber-optic monitoring of jugular bulb venous oxygen saturation (SjO2), in conjunction with continuous monitoring of mixed venous oxygen saturation (SvO2). Three patients survived and 5 died. SjO2 and SvO2 patterns were compared between surviving and non-surviving patients with regard to their prognostic and therapeutic implications. The mean SjO2 of the survivors (67%) was significantly lower than that of the non-survivors (80%) (P < 0.001), whereas the corresponding SvO2 value was higher in the survivor group (74%) than in the non-survivor group (64%) (P < 0.001). Three of the non-survivors died of brain death within 5 days after resuscitation, and then the others died of respiratory or cardiovascular failure without recovering from deep coma. The high SjO2 of the non-survivors suggests that an inability of damaged neurons to use oxygen may be an indicator of poor neurological outcome in resuscitated patients after cardiac arrest. When SjO2 was < 45%, Sv-O2 was extremely low, reflecting cardiovascular failure after resuscitation. SjO2 may thus serve to warn of deterioration in cardiopulmonary function and serve as a predictor of outcome in cardiac arrest survivors.
Takasu
A
A
Department of Traumatology and Critical Care Medicine, National Defense Medical College, Saitama, Japan.
Yagi
K
K
Ishihara
S
S
Okada
Y
Y
D001921:Brain / Q000378:metabolism*; D001926:Brain Death / Q000378:metabolism; D002302:Cardiac Output; D016022:Case-Control Studies; D005260:Female; D006323:Heart Arrest / Q000378:metabolism* / Q000401:mortality / Q000628:therapy; D006801:Humans; D007601:Jugular Veins; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods; D010092:Oximetry / Q000379:methods; D010100:Oxygen / Q000097:blood*; D010101:Oxygen Consumption / Q000502:physiology*; D011379:Prognosis; D012151:Resuscitation
D010100:Oxygen