Abstract
Background
Optimal cerebral oxygenation is considered fundamental to cerebral protection in cardiac
arrest (CA) patients. Hypercapnia increases cerebral blood flow and may also improve
cerebral oxygenation. It is uncertain, however, whether this effect occurs in mechanically
ventilated early survivors of CA.
Methods
We enrolled mechanically ventilated resuscitated patients within 36 h of their cardiac arrest. We performed a prospective double cross-over physiological
study comparing the impact of normocapnia (PaCO2 35–45 mmHg) vs. mild hypercapnia (PaCO2 45–55 mmHg) on regional cerebral tissue oxygen saturation (SctO2) assessed by near infrared spectroscopy (NIRS).
Results
We studied seven adult CA patients with a median time to return of spontaneous circulation
of 28 min at a median of 26 h and 30 min after CA. During normocapnia (median EtCO2 of 32 mmHg [30–41 mmHg] and PaCO2 of 37 mmHg [32–45 mmHg]) the median NIRS-derived left frontal SctO2 was 61% [52–65%] and the right frontal SctO2 was 61% [54–68%]. However, during mild hypercapnia (median EtCO2 of 49 mmHg [40–57 mmHg] and PaCO2 of 52 mmHg [43–55 mmHg) the median left frontal SctO2 increased to 69% [59–78%] and the right frontal SctO2 increased to 73% [61–76%])(p = 0.001, for all comparisons).
Conclusion
During the early post-resuscitation period, in mechanically ventilated CA patients,
mild hypercapnia increases cerebral oxygenation as assessed by NIRS. Further investigations
of the effect of prolonged mild hypercapnia on cerebral oxygenation and patient outcomes
appear justified.
Keywords
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References
- Neuropsycholoigcal and neurological sequelae of out-of-hospital cardiac arrest and estimated need for neurorehabilitation: a prospective pilot study.Kardiol Pol. 2014; 72: 814-822
- Arterial blood gas tensions after resuscitation from out-of-hospital cardiac arrest: associations with long-term neurological outcome.Crit Care Med. 2014; 42: 1463-1470
- Cerebral tissue oxygen saturation during therapeutic hypothermia in post-cardiac arrest patients.Resuscitation. 2013; 84: 788-793
- Hyperoxia in the intensive care unit and outcome after out-of-hospital ventricular fibrillation cardiac arrest.Crit Care Resusc. 2013; 15: 186-190
- Autoregulation of cerebral blood flow in patients resuscitated from cardiac arrest.Stroke. 2001; 32: 128-132
- Total cerebral ischemia: effect of alterations in arterial PCO2 on cerebral microcirculation.J Cereb Blood Flow Metab. 1984; 4: 343-349
- Arterial carbon dioxide tension and outcome in patients admitted to the intensive care unit after cardiac arrest.Resuscitation. 2013; 84: 488-495
- Regulation of cerebral autoregulation by carbon dioxide.Anesthesiology. 2015; 122: 196-205
- An update on cerebral oxygenation monitoring, an innovative application in cardiac arrest and neurological emergencies.in: Vincent JL Annual update in intensive care and emergency medicine 2015. Springer International Publishing, Heidelberg2015: 273-286
- Near infrared spectrophotometry (cerebral oximetry) in predicting the return of spontaneous circulation in out-of-hospital cardiac arrest.Am J Emerg Med. 2014; 32: 14-17
- A feasibility study of cerebral oximetry monitoring during the post-resuscitation period in comatose patients following cardiac arrest.Resuscitation. 2014; 85: 522-526
- Regional cerebral oxygen saturation after cardiac arrest in 60 patients—a prospective outcome study.Resuscitation. 2014; 85: 1037-1041
- Cerebral blood flow after cardiac arrest.Neth J Med. 2000; 57: 106-112
- Post-cardiac arrest syndrome: epidemiology, pathophysiology, treatment, and prognostication: a scientific statement from the International liaison Committee on Resuscitation; the American Heart Association Emergency cardiovascular Care Committee; the Council on Cardiovascular Surgery and Anesthesia; the Council on cardiopulmonary, Perioperative, and Critical Care; the Council on clinical cardiology; the Council on Stroke.Resuscitation. 2008; 79: 350-379
- Preserved metabolic coupling and cerebrovascular reactivity during mild hypothermia after cardiac arrest.Crit Care Med. 2010; 38: 1542-1547
- Therapeutic hypothermia after cardiac arrest—cerebral perfusion and metabolism during upper and lower threshold normocapnia.Resuscitation. 2011; 83: 1174-1179
- A pilot assessment of alpha-stat vs pH-stat arterial blood gas analysis after cardiac arrest.J Crit Care. 2015; 30: 138-144
- Influence of α-Stat and pH-Stat blood gas management strategies on cerebral blood flow and oxygenation in patients treated with therapeutic hypothermia after out-of-hospital cardiac arrest: a crossover study.Crit Care Med. 2014; 42: 1849-1861
- A pilot feasibility, safety and biological efficacy multicentre trial of therapeutic hypercapnia after cardiac arrest: study protocol for a randomized controlled trial.Trials. 2015; 16: 135
- Cerebrovascular and systemic hemodynamic response to carbon dioxide in humans.Blood Press Monit. 2014; 19: 81-89
- Cerebral blood flow and metabolism after cardiopulmonary resuscitation. A pathophysiologic and prognostic positron emission tomography pilot study.Resuscitation. 2003; 53: 161-170
- Prognostic significance of the difference between mixed venous and jugular bulb oxygen saturation in comatose patients resuscitated from a cardiac arrest.Resuscitation. 1999; 41: 257-262
- Cerebral blood flow and metabolism in man following cardiac arrest.Stroke. 1978; 9: 569-573
Article info
Publication history
Published online: February 20, 2016
Accepted:
February 6,
2016
Received in revised form:
January 21,
2016
Received:
August 14,
2015
Footnotes
☆A Spanish translated version of the summary of this article appears as Appendix in the final online version at http://dx.doi.org/10.1016/j.resuscitation.2016.02.009.
Identification
Copyright
© 2016 Elsevier Ireland Ltd. Published by Elsevier Inc. All rights reserved.
