title: Changes of cerebral oxygen metabolism and hemodynamics during ECPR with hypothermia measured by near-infrared spectroscopy: a pilot study.
abstract: BACKGROUND
  The 2010 CPR Guidelines recommend that extracorporeal cardiopulmonary resuscitation (ECPR) using an emergency cardiopulmonary bypass (CPB) should be considered for patients with cardiac arrest. However, it is not yet clear whether this therapy can improve cerebral circulation and oxygenation in these patients. To clarify this issue, we evaluated changes of cerebral blood oxygenation (CBO) during ECPR using near-infrared spectroscopy (NIRS).
  
  
  METHODS
  We employed NIRS to measure CBO in the bilateral frontal lobe in patients transported to the emergency room (ER) after out-of-hospital cardiac arrest between November 2009 and June 2011.
  
  
  RESULTS
  Fifteen patients met the above criteria. The tissue oxygenation index (TOI) on arrival at the ER was 36.5 %. This increased to 67.8 % during ECPR (P < 0.001). The one patient whose TOI subsequently decreased had a favorable neurological outcome.
  
  
  CONCLUSIONS
  Increase of TOI during ECPR might reflect an improvement in cerebral blood flow, while decrease of TOI after ECPR might reflect oxygen utilization by the brain tissue as a result of neuronal cell survival. NIRS may be useful for monitoring cerebral hemodynamics and oxygen metabolism during CPR.
authors.affiliation: Department of Cardiology, Cardiopulmonary Resuscitation and Emergency Cardiovascular Care, Surugadai Nihon University Hospital, 1-8-13 Kanda Surugadai, Chiyoda-ku, Tokyo, 101-8309, Japan. ygt0108@livedoor.com.|Department of Emergency and Critical Care Medicine, Surugadai Nihon University Hospital, Tokyo, Japan. ygt0108@livedoor.com.|Department of Cardiology, Kawaguchi Municipal Medical Center, Kawaguchi, Japan. ygt0108@livedoor.com.
authors.forename: Tsukasa
authors.initials: T
authors.lastname: Yagi
authors.affiliation: Department of Cardiology, Cardiopulmonary Resuscitation and Emergency Cardiovascular Care, Surugadai Nihon University Hospital, 1-8-13 Kanda Surugadai, Chiyoda-ku, Tokyo, 101-8309, Japan.
authors.forename: Ken
authors.initials: K
authors.lastname: Nagao
authors.affiliation: Department of Electrical and Electronics Engineering, Nihon University College of Engineering, Koriyama, Japan.
authors.forename: Kaoru
authors.initials: K
authors.lastname: Sakatani
authors.affiliation: Department of Emergency and Critical Care Medicine, Surugadai Nihon University Hospital, Tokyo, Japan.
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Kawamorita
authors.affiliation: Department of Cardiology, Cardiopulmonary Resuscitation and Emergency Cardiovascular Care, Surugadai Nihon University Hospital, 1-8-13 Kanda Surugadai, Chiyoda-ku, Tokyo, 101-8309, Japan.|Department of Emergency and Critical Care Medicine, Surugadai Nihon University Hospital, Tokyo, Japan.
authors.forename: Taketomo
authors.initials: T
authors.lastname: Soga
authors.affiliation: Department of Cardiology, Cardiopulmonary Resuscitation and Emergency Cardiovascular Care, Surugadai Nihon University Hospital, 1-8-13 Kanda Surugadai, Chiyoda-ku, Tokyo, 101-8309, Japan.|Department of Emergency and Critical Care Medicine, Surugadai Nihon University Hospital, Tokyo, Japan.
authors.forename: Kimio
authors.initials: K
authors.lastname: Kikushima
authors.affiliation: Department of Cardiology, Cardiopulmonary Resuscitation and Emergency Cardiovascular Care, Surugadai Nihon University Hospital, 1-8-13 Kanda Surugadai, Chiyoda-ku, Tokyo, 101-8309, Japan.|Department of Emergency and Critical Care Medicine, Surugadai Nihon University Hospital, Tokyo, Japan.
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Watanabe
authors.affiliation: Department of Cardiology, Cardiopulmonary Resuscitation and Emergency Cardiovascular Care, Surugadai Nihon University Hospital, 1-8-13 Kanda Surugadai, Chiyoda-ku, Tokyo, 101-8309, Japan.|Department of Cardiology, Kawaguchi Municipal Medical Center, Kawaguchi, Japan.
authors.forename: Eizo
authors.initials: E
authors.lastname: Tachibana
authors.affiliation: Department of Emergency and Critical Care Medicine, Surugadai Nihon University Hospital, Tokyo, Japan.
authors.forename: Yoshiteru
authors.initials: Y
authors.lastname: Tominaga
authors.affiliation: Department of Emergency and Critical Care Medicine, Surugadai Nihon University Hospital, Tokyo, Japan.
authors.forename: Katsushige
authors.initials: K
authors.lastname: Tada
authors.affiliation: Department of Emergency and Critical Care Medicine, Surugadai Nihon University Hospital, Tokyo, Japan.
authors.forename: Ishii
authors.initials: I
authors.lastname: Mitsuru
authors.affiliation: Department of Emergency and Critical Care Medicine, Surugadai Nihon University Hospital, Tokyo, Japan.
authors.forename: Nobutaka
authors.initials: N
authors.lastname: Chiba
authors.affiliation: Department of Cardiology, Cardiopulmonary Resuscitation and Emergency Cardiovascular Care, Surugadai Nihon University Hospital, 1-8-13 Kanda Surugadai, Chiyoda-ku, Tokyo, 101-8309, Japan.|Department of Emergency and Critical Care Medicine, Surugadai Nihon University Hospital, Tokyo, Japan.
authors.forename: Kei
authors.initials: K
authors.lastname: Nishikawa
authors.affiliation: Department of Cardiology, Cardiopulmonary Resuscitation and Emergency Cardiovascular Care, Surugadai Nihon University Hospital, 1-8-13 Kanda Surugadai, Chiyoda-ku, Tokyo, 101-8309, Japan.|Department of Emergency and Critical Care Medicine, Surugadai Nihon University Hospital, Tokyo, Japan.
authors.forename: Masakazu
authors.initials: M
authors.lastname: Matsuzaki
authors.affiliation: Department of Cardiology, Cardiopulmonary Resuscitation and Emergency Cardiovascular Care, Surugadai Nihon University Hospital, 1-8-13 Kanda Surugadai, Chiyoda-ku, Tokyo, 101-8309, Japan.|Department of Emergency and Critical Care Medicine, Surugadai Nihon University Hospital, Tokyo, Japan.
authors.forename: Harumi
authors.initials: H
authors.lastname: Hirose
authors.affiliation: Department of Emergency and Critical Care Medicine, Surugadai Nihon University Hospital, Tokyo, Japan.|Division of Neurosurgery, Department of Neurological Surgery, Nihon University School of Medicine, Tokyo, Japan.
authors.forename: Atsuo
authors.initials: A
authors.lastname: Yoshino
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Nihon University School of Medicine, Tokyo, Japan.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Hirayama
mesh_terms: D016887:Cardiopulmonary Resuscitation / Q000379:methods; D002560:Cerebrovascular Circulation / Q000502:physiology*; D054022:Cerebrum / Q000098:blood supply* / Q000378:metabolism*; D005260:Female; D006439:Hemodynamics; D006801:Humans; D007035:Hypothermia / Q000097:blood / Q000378:metabolism*; D008297:Male; D008875:Middle Aged; D058687:Out-of-Hospital Cardiac Arrest / Q000378:metabolism; D010100:Oxygen / Q000097:blood / Q000378:metabolism*; D010101:Oxygen Consumption / Q000502:physiology; D019265:Spectroscopy, Near-Infrared / Q000379:methods
chemical_list: D010100:Oxygen