Improving the neurological prognosis following OHCA using real-time evaluation of cerebral tissue oxygenation

Am J Emerg Med. 2018 Feb;36(2):344.e5-344.e7. doi: 10.1016/j.ajem.2017.11.029. Epub 2017 Nov 13.

Abstract

Background: The neurological prognosis is poor for patients suffering from out-of-hospital cardiac arrest (OHCA), in the absence of bystander cardio pulmonary resuscitation (CPR), and showing asystole as the initial waveform. However, such patients have the potential of resuming social activity if cerebral tissue oxygen saturation can be preserved.

Case presentation: We recently encountered a 60-year-old man who had suffered an OHCA in the absence of bystander CPR, and who successfully resumed complete social activity despite initial asystole and requiring at least 75min of chest compressions before return of spontaneous circulation (ROSC). In this case, chest compression was appropriately performed concurrently with real-time evaluation of cerebral tissue oxygenation using near-infrared spectroscopy (NIRS). As a result, the cerebral tissue oxygenation was well maintained, leading to resumption of social activity.

Conclusions: Improved neurological prognoses can be expected if OHCA patients with the potential for social activity resumption are identified, using NIRS, and effective cardiopulmonary and cerebral resuscitation is performed while visually checking CPR quality.

Keywords: Cardiac arrest; Cardio pulmonary resuscitation; Cerebral tissue oxygenation; Evaluate CPR efficacy; Near-infrared spectroscopy; Neurological prognoses; Real-time cerebral blood flow monitoring.

Publication types

  • Case Reports

MeSH terms

  • Cardiopulmonary Resuscitation / methods*
  • Cerebrovascular Circulation / physiology*
  • Humans
  • Male
  • Middle Aged
  • Out-of-Hospital Cardiac Arrest / metabolism
  • Out-of-Hospital Cardiac Arrest / physiopathology
  • Out-of-Hospital Cardiac Arrest / therapy*
  • Oximetry / methods
  • Oxygen / metabolism*
  • Oxygen Consumption / physiology*
  • Spectroscopy, Near-Infrared / methods

Substances

  • Oxygen