Neurochemical monitoring using intracerebral microdialysis during cardiac resuscitation.
OBJECTIVE
After cardiac resuscitation, hypoxic encephalopathy often is the limiting factor regarding outcome due to the oxygen sensitivity of the brain. Intracerebral microdialysis is a highly sensitive technique to monitor cerebral energy metabolism and for the early detection of cerebral hypoxia. PATIENT AND INTERVENTIONS: A 34-year-old male patient who had to be craniectomized due to a mass demanding middle cerebral artery infarct. A microdialysis catheter was inserted into the left frontal lobe and, as control, into the abdominal subcutaneous adipose tissue. Pulmonary embolism and asystolia leading to cardiac resuscitation occurred.


RESULTS
The cerebral chemical markers of energy metabolism glucose, lactate, pyruvate, and the marker of cell membrane damage glycerol were measured. Except for subcutaneous glucose, all markers showed a sudden and significant increase during resuscitation and a prolonged period afterwards. After some hours all values returned to normal.


CONCLUSIONS
This is the first reported case of monitoring neurochemical markers using intracerebral microdialysis during cardiac resuscitation. The findings indicate the importance of early and efficient resuscitation and demonstrate that deviations in cerebral energy metabolism are reversible.
Department of Neurosurgery, University Hospital Innsbruck, Leopold-Franzens-University Innsbruck, Austria. richardbauer68@hotmail.com
Richard
R
Bauer
Michael
M
Gabl
Alois
A
Obwegeser
Klaus
K
Galiano
Josef
J
Barbach
Iradj
I
Mohsenipour
D000328:Adult; D015415:Biomarkers / Q000032:analysis; D001923:Brain Chemistry; D002423:Cause of Death; D002544:Cerebral Infarction / Q000150:complications; D004734:Energy Metabolism; D017809:Fatal Outcome; D005990:Glycerol / Q000032:analysis / Q000378:metabolism; D006019:Glycolysis; D006323:Heart Arrest / Q000150:complications* / Q000628:therapy; D006336:Heart Massage; D006801:Humans; D002534:Hypoxia, Brain / Q000175:diagnosis* / Q000209:etiology* / Q000378:metabolism; D007427:Intracranial Pressure; D019344:Lactic Acid / Q000032:analysis / Q000378:metabolism; D008297:Male; D017551:Microdialysis / Q000379:methods*; D008991:Monitoring, Physiologic / Q000379:methods*; D011655:Pulmonary Embolism / Q000150:complications; D019289:Pyruvic Acid / Q000032:analysis / Q000378:metabolism
D015415:Biomarkers; D019344:Lactic Acid; D019289:Pyruvic Acid; D005990:Glycerol