Cerebral desaturation during cardiac arrest: Its relation to arrest duration and left ventricular pump function
OBJECTIVE:To determine the impact of brief periods of cardiac arrest (CA) on regional cerebral oxygen saturation (rSo2) in patients with low left ventricular ejection fraction (LVEF 50%), moderately impaired (LVEF 30%–50%), or severely reduced (LVEF
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| Veröffentlicht in: | Critical care medicine 2009-02, Vol.37 (2), p.471-475 |
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| container_title | Critical care medicine |
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| creator | Skhirtladze, Keso Birkenberg, Beatrice Mora, Bruno Moritz, Andrea Ince, Ismail Ankersmit, Hendrik J Szeinlechner, Barbara Dworschak, Martin |
| description | OBJECTIVE:To determine the impact of brief periods of cardiac arrest (CA) on regional cerebral oxygen saturation (rSo2) in patients with low left ventricular ejection fraction (LVEF 50%), moderately impaired (LVEF 30%–50%), or severely reduced (LVEF |
| doi_str_mv | 10.1097/CCM.0b013e3181953d4c |
| format | Article |
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DESIGN:Prospective observational study.
SETTING:Cardiac surgery room at a university hospital.
PATIENTS:Seventy-seven consecutive patients undergoing elective implantation of a cardioverter/defibrillator in monitored anesthesia care. According to preoperative assessments, left ventricular function was classified as normal (LVEF >50%), moderately impaired (LVEF 30%–50%), or severely reduced (LVEF <30%).
INTERVENTIONS:None.
MEASUREMENTS AND MAIN RESULTS:rSo2 was determined during threshold testing with concomitant induction of CA. In patients with LVEF <30%, mean baseline rSo2 (59%) was already below the lower range of normal despite normal arterial blood pressure, heart rate, and arterial oxygen saturation. rSo2 increased by 6% after 6 L/min oxygen insufflation (p < 0.05) and dropped again in each group after CA, reaching a nadir after successful defibrillation. Patients with LVEF <30% and baseline rSo2 ≤63% exhibited the lowest values. They also showed the highest incidence (11%) of critical cerebral desaturations (i.e., >20% drop from baseline or rSo2 value <50%). rSo2 in patients with LVEF <30% was always below that determined in patients with LVEF >30% (p < 0.05). There was a strong correlation between rSo2 values before CA and rSo2 nadir (p < 0.05). The drop in rSo2 was only moderately related to the brief CAs (p < 0.05).
CONCLUSION:These findings demonstrate that severely compromised left ventricular pump function is associated with diminished rSo2. As these patients seem to be more susceptible to critical desaturations, they may be prone to severe tissue hypoxemia unless adequate oxygen delivery is reestablished rapidly. This may contribute to the poor neurologic outcome after successful resuscitation in patients with LVEF <30%.]]></description><identifier>ISSN: 0090-3493</identifier><identifier>EISSN: 1530-0293</identifier><identifier>DOI: 10.1097/CCM.0b013e3181953d4c</identifier><identifier>PMID: 19114911</identifier><identifier>CODEN: CCMDC7</identifier><language>eng</language><publisher>Hagerstown, MD: by the Society of Critical Care Medicine and Lippincott Williams & Wilkins</publisher><subject>Aged ; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy ; Biological and medical sciences ; Blood Pressure ; Brain - metabolism ; Emergency and intensive cardiocirculatory care. Cardiogenic shock. Coronary intensive care ; Female ; Heart Arrest - physiopathology ; Hospitals, University ; Humans ; Intensive care medicine ; Male ; Medical sciences ; Middle Aged ; Oxygen Consumption - physiology ; Ventricular Fibrillation - physiopathology ; Ventricular Function, Left</subject><ispartof>Critical care medicine, 2009-02, Vol.37 (2), p.471-475</ispartof><rights>2009 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins</rights><rights>2009 INIST-CNRS</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4461-1d8615b01eda699e600d54e6edad5edfcd284f3047f5100eba6072a2b58bf8be3</citedby><cites>FETCH-LOGICAL-c4461-1d8615b01eda699e600d54e6edad5edfcd284f3047f5100eba6072a2b58bf8be3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27915,27916</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=21173434$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/19114911$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Skhirtladze, Keso</creatorcontrib><creatorcontrib>Birkenberg, Beatrice</creatorcontrib><creatorcontrib>Mora, Bruno</creatorcontrib><creatorcontrib>Moritz, Andrea</creatorcontrib><creatorcontrib>Ince, Ismail</creatorcontrib><creatorcontrib>Ankersmit, Hendrik J</creatorcontrib><creatorcontrib>Szeinlechner, Barbara</creatorcontrib><creatorcontrib>Dworschak, Martin</creatorcontrib><title>Cerebral desaturation during cardiac arrest: Its relation to arrest duration and left ventricular pump function</title><title>Critical care medicine</title><addtitle>Crit Care Med</addtitle><description><![CDATA[OBJECTIVE:To determine the impact of brief periods of cardiac arrest (CA) on regional cerebral oxygen saturation (rSo2) in patients with low left ventricular ejection fraction (LVEF <30%).
DESIGN:Prospective observational study.
SETTING:Cardiac surgery room at a university hospital.
PATIENTS:Seventy-seven consecutive patients undergoing elective implantation of a cardioverter/defibrillator in monitored anesthesia care. According to preoperative assessments, left ventricular function was classified as normal (LVEF >50%), moderately impaired (LVEF 30%–50%), or severely reduced (LVEF <30%).
INTERVENTIONS:None.
MEASUREMENTS AND MAIN RESULTS:rSo2 was determined during threshold testing with concomitant induction of CA. In patients with LVEF <30%, mean baseline rSo2 (59%) was already below the lower range of normal despite normal arterial blood pressure, heart rate, and arterial oxygen saturation. rSo2 increased by 6% after 6 L/min oxygen insufflation (p < 0.05) and dropped again in each group after CA, reaching a nadir after successful defibrillation. Patients with LVEF <30% and baseline rSo2 ≤63% exhibited the lowest values. They also showed the highest incidence (11%) of critical cerebral desaturations (i.e., >20% drop from baseline or rSo2 value <50%). rSo2 in patients with LVEF <30% was always below that determined in patients with LVEF >30% (p < 0.05). There was a strong correlation between rSo2 values before CA and rSo2 nadir (p < 0.05). The drop in rSo2 was only moderately related to the brief CAs (p < 0.05).
CONCLUSION:These findings demonstrate that severely compromised left ventricular pump function is associated with diminished rSo2. As these patients seem to be more susceptible to critical desaturations, they may be prone to severe tissue hypoxemia unless adequate oxygen delivery is reestablished rapidly. This may contribute to the poor neurologic outcome after successful resuscitation in patients with LVEF <30%.]]></description><subject>Aged</subject><subject>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</subject><subject>Biological and medical sciences</subject><subject>Blood Pressure</subject><subject>Brain - metabolism</subject><subject>Emergency and intensive cardiocirculatory care. Cardiogenic shock. Coronary intensive care</subject><subject>Female</subject><subject>Heart Arrest - physiopathology</subject><subject>Hospitals, University</subject><subject>Humans</subject><subject>Intensive care medicine</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Oxygen Consumption - physiology</subject><subject>Ventricular Fibrillation - physiopathology</subject><subject>Ventricular Function, Left</subject><issn>0090-3493</issn><issn>1530-0293</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2009</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpdkU1v1DAQhi0EokvhHyDkC9xSZmLHSbihiI9KRb2Us-XYExrwJos_WvXf16uNAGHJtmb0zHj8voy9RrhA6Nv3w_DtAkZAQQI77BvhpH3CdtgIqKDuxVO2A-ihErIXZ-xFjD8BUDateM7OsEeUZe_YOlCgMRjPHUWTcjBpXhfucpiXH9ya4GZjuQmBYvrAL1PkgfyJSeuWP9KnlFkc9zQlfkdLCrPN3gR-yPsDn_Jij8hL9mwyPtKr7T5n3z9_uhm-VlfXXy6Hj1eVlVJhha5T2JTfkTOq70kBuEaSKqFryE3W1Z2cBMh2ahCARqOgrU09Nt04dSOJc_bu1PcQ1t-5DKn3c7TkvVlozVGrFkFhKwsoT6ANa4yBJn0I896EB42gj0LrIrT-X-hS9mbrn8c9ub9Fm7IFeLsBJlrjp2AWO8c_XI3YCin-ef9-9YlC_OXzPQV9S8anWw1liVqqqj56WY7ibbERxSNo6JkO</recordid><startdate>200902</startdate><enddate>200902</enddate><creator>Skhirtladze, Keso</creator><creator>Birkenberg, Beatrice</creator><creator>Mora, Bruno</creator><creator>Moritz, Andrea</creator><creator>Ince, Ismail</creator><creator>Ankersmit, Hendrik J</creator><creator>Szeinlechner, Barbara</creator><creator>Dworschak, Martin</creator><general>by the Society of Critical Care Medicine and Lippincott Williams & Wilkins</general><general>Lippincott Williams & Wilkins</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>200902</creationdate><title>Cerebral desaturation during cardiac arrest: Its relation to arrest duration and left ventricular pump function</title><author>Skhirtladze, Keso ; Birkenberg, Beatrice ; Mora, Bruno ; Moritz, Andrea ; Ince, Ismail ; Ankersmit, Hendrik J ; Szeinlechner, Barbara ; Dworschak, Martin</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4461-1d8615b01eda699e600d54e6edad5edfcd284f3047f5100eba6072a2b58bf8be3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2009</creationdate><topic>Aged</topic><topic>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</topic><topic>Biological and medical sciences</topic><topic>Blood Pressure</topic><topic>Brain - metabolism</topic><topic>Emergency and intensive cardiocirculatory care. Cardiogenic shock. Coronary intensive care</topic><topic>Female</topic><topic>Heart Arrest - physiopathology</topic><topic>Hospitals, University</topic><topic>Humans</topic><topic>Intensive care medicine</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Oxygen Consumption - physiology</topic><topic>Ventricular Fibrillation - physiopathology</topic><topic>Ventricular Function, Left</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Skhirtladze, Keso</creatorcontrib><creatorcontrib>Birkenberg, Beatrice</creatorcontrib><creatorcontrib>Mora, Bruno</creatorcontrib><creatorcontrib>Moritz, Andrea</creatorcontrib><creatorcontrib>Ince, Ismail</creatorcontrib><creatorcontrib>Ankersmit, Hendrik J</creatorcontrib><creatorcontrib>Szeinlechner, Barbara</creatorcontrib><creatorcontrib>Dworschak, Martin</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Critical care medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Skhirtladze, Keso</au><au>Birkenberg, Beatrice</au><au>Mora, Bruno</au><au>Moritz, Andrea</au><au>Ince, Ismail</au><au>Ankersmit, Hendrik J</au><au>Szeinlechner, Barbara</au><au>Dworschak, Martin</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Cerebral desaturation during cardiac arrest: Its relation to arrest duration and left ventricular pump function</atitle><jtitle>Critical care medicine</jtitle><addtitle>Crit Care Med</addtitle><date>2009-02</date><risdate>2009</risdate><volume>37</volume><issue>2</issue><spage>471</spage><epage>475</epage><pages>471-475</pages><issn>0090-3493</issn><eissn>1530-0293</eissn><coden>CCMDC7</coden><abstract><![CDATA[OBJECTIVE:To determine the impact of brief periods of cardiac arrest (CA) on regional cerebral oxygen saturation (rSo2) in patients with low left ventricular ejection fraction (LVEF <30%).
DESIGN:Prospective observational study.
SETTING:Cardiac surgery room at a university hospital.
PATIENTS:Seventy-seven consecutive patients undergoing elective implantation of a cardioverter/defibrillator in monitored anesthesia care. According to preoperative assessments, left ventricular function was classified as normal (LVEF >50%), moderately impaired (LVEF 30%–50%), or severely reduced (LVEF <30%).
INTERVENTIONS:None.
MEASUREMENTS AND MAIN RESULTS:rSo2 was determined during threshold testing with concomitant induction of CA. In patients with LVEF <30%, mean baseline rSo2 (59%) was already below the lower range of normal despite normal arterial blood pressure, heart rate, and arterial oxygen saturation. rSo2 increased by 6% after 6 L/min oxygen insufflation (p < 0.05) and dropped again in each group after CA, reaching a nadir after successful defibrillation. Patients with LVEF <30% and baseline rSo2 ≤63% exhibited the lowest values. They also showed the highest incidence (11%) of critical cerebral desaturations (i.e., >20% drop from baseline or rSo2 value <50%). rSo2 in patients with LVEF <30% was always below that determined in patients with LVEF >30% (p < 0.05). There was a strong correlation between rSo2 values before CA and rSo2 nadir (p < 0.05). The drop in rSo2 was only moderately related to the brief CAs (p < 0.05).
CONCLUSION:These findings demonstrate that severely compromised left ventricular pump function is associated with diminished rSo2. As these patients seem to be more susceptible to critical desaturations, they may be prone to severe tissue hypoxemia unless adequate oxygen delivery is reestablished rapidly. This may contribute to the poor neurologic outcome after successful resuscitation in patients with LVEF <30%.]]></abstract><cop>Hagerstown, MD</cop><pub>by the Society of Critical Care Medicine and Lippincott Williams & Wilkins</pub><pmid>19114911</pmid><doi>10.1097/CCM.0b013e3181953d4c</doi><tpages>5</tpages></addata></record> |
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| ispartof | Critical care medicine, 2009-02, Vol.37 (2), p.471-475 |
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| source | MEDLINE; Journals@Ovid Complete |
| subjects | Aged Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy Biological and medical sciences Blood Pressure Brain - metabolism Emergency and intensive cardiocirculatory care. Cardiogenic shock. Coronary intensive care Female Heart Arrest - physiopathology Hospitals, University Humans Intensive care medicine Male Medical sciences Middle Aged Oxygen Consumption - physiology Ventricular Fibrillation - physiopathology Ventricular Function, Left |
| title | Cerebral desaturation during cardiac arrest: Its relation to arrest duration and left ventricular pump function |
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