title: The pitfalls of bedside regional cerebral oxygen saturation in the early stage of post cardiac arrest.
abstract: It remains uncertain whether neuromonitoring reliably predicts outcome in adult post-cardiac arrest patients in the early stage treated with therapeutic hypothermia. Recent reports demonstrated a regional cerebral oxygen saturation of cardiac arrest patients on hospital arrival could predict their neurological outcome. There has been little discussion about the significance of regional cerebral oxygen saturation in patients with post-cardiac arrest syndrome. Amplitude-integrated electroencephalography monitoring may also provide early prognostic information for post-cardiac arrest syndrome. However, even when the initial electroencephalography is flat after the return of spontaneous circulation, good neurological outcome may still be obtainable if the electroencephalography shifts to a continuous pattern. The electroencephalography varied from flat to various patterns, such as flat, epileptic, or continuous during the first 24 h, while regional cerebral oxygen saturation levels varied even when the electroencephalography was flat. It is therefore difficult to estimate whether regional cerebral oxygen saturation accurately indicates the coupling of cerebral blood flow and metabolism in the early stage after cardiac arrest. Careful assessment of prognosis is necessary when relying solely on regional cerebral oxygen saturation as a single monitoring modality.
authors.affiliation: Division of Emergency and Critical Care Medicine, Department of Acute Medicine, Nihon University School of Medicine, 30-1 Oyaguchi Kamimachi Itabashi-ku, Tokyo, 173-8610, Japan. kinoshita.kosaku@nihon-u.ac.jp.
authors.forename: Kosaku
authors.initials: K
authors.lastname: Kinoshita
authors.affiliation: Division of Emergency and Critical Care Medicine, Department of Acute Medicine, Nihon University School of Medicine, 30-1 Oyaguchi Kamimachi Itabashi-ku, Tokyo, 173-8610, Japan.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Sakurai
authors.affiliation: Division of Emergency and Critical Care Medicine, Department of Acute Medicine, Nihon University School of Medicine, 30-1 Oyaguchi Kamimachi Itabashi-ku, Tokyo, 173-8610, Japan.
authors.forename: Shingo
authors.initials: S
authors.lastname: Ihara
mesh_terms: D000328:Adult; D000368:Aged; D016887:Cardiopulmonary Resuscitation / Q000379:methods / Q000401:mortality; D002560:Cerebrovascular Circulation / Q000502:physiology*; D004569:Electroencephalography / Q000379:methods; D005260:Female; D006323:Heart Arrest / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy*; D006801:Humans; D007036:Hypothermia, Induced / Q000379:methods / Q000401:mortality; D008297:Male; D008875:Middle Aged; D010092:Oximetry; D010101:Oxygen Consumption / Q000502:physiology*; D010108:Oxyhemoglobins / Q000032:analysis; D000067716:Point-of-Care Testing; D012680:Sensitivity and Specificity; D016019:Survival Analysis; D013997:Time Factors
chemical_list: D010108:Oxyhemoglobins