[Cerebral monitoring with trancranial doppler-sonography and cerebrovenous oximetry during resuscitation].
This case report describes cerebral monitoring of intracranial haemodynamics using transcranial Doppler sonography (TCD) and jugular bulb oxygen saturation (SjO2) by fiberoptic jugular bulb oximetry during cardiac arrest following cardiac surgery involving cardiopulmonary bypass (CPB). CPB for aortic valve replacement and coronary artery bypass grafting was performed in a 63-year-old patient previously operated upon for heart disease. Mean blood flow velocity was measured in the middle cerebral artery using a bidirectional 2 MHz TCD system. SjO2 was measured using a fiberoptic thermodilution catheter placed in the right jugular bulb via the right internal jugular vein under radiographic control. At the end of the operation, low cardiac output syndrome and cardiac arrest occurred, which required reopening of the thorax and cardiopulmonary resuscitation (CPR) until CPB could be resumed. Following extrathoracic cardiac resuscitation, systolic "spikes", loss of the diastolic flow profile, and no increase in SjO2 were recorded by the monitors, indicating cerebral circulatory arrest. However, a normal flow profile with increasing diastolic portions and an increase in SjO2 to 52% were seen following optimisation of the open thorax cardiac resuscitation. This monitoring may be able to give information to optimise therapy during CPR to avoid ischaemic cerebral injury.
Abteilung für Anästhesiologie, Universitäts-Krankenhaus Eppendorf, Hamburg.
G
G
von Knobelsdorff
M
M
Goerig
C
C
Werner
J
J
Schulte am Esch
D000758:Anesthesia; D001923:Brain Chemistry / Q000502:physiology; D002315:Cardiopulmonary Bypass; D002560:Cerebrovascular Circulation / Q000502:physiology; D005336:Fiber Optic Technology; D006324:Heart Arrest, Induced; D006350:Heart Valve Prosthesis; D006801:Humans; D008297:Male; D008875:Middle Aged; D010092:Oximetry; D012151:Resuscitation; D017585:Ultrasonography, Doppler, Transcranial
Erweitertes zerebrales Monitoring mit transkranieller Doppler-Sonographie und zerebrovenöser Oxymetrie während einer Reanimation.