Mehmet Akif YAZAR, Adnan BAYRAM, Mehmet Barış AÇIKGÖZ

Does chest compression during cardiopulmonary resuscitation provide sufficient cerebral oxygenation?

Background/aim: Some of the patients suffering from cardiac arrest (CA) remain in a chronic unconscious state in intensive careunits (ICUs). The primary aim of this study was to evaluate the efficacy of chest compression (CC) on cerebral oxygenation duringcardiopulmonary resuscitation (CPR). As a secondary goal, we attempted to determine the effects of regional cerebral oxygen saturation(rSO2) values on consciousness and the survival rate using the Full Outline of Unresponsiveness (FOUR) scoring method.Materials and methods: This observational preliminary study was carried out with 20 patients with CA who were hospitalized inICUs. The rSO2 values measured by near-infrared spectroscopy were recorded during CA. FOUR scoring was used to determine theneurological status, severity of disease, and degree of organ dysfunction in survivors.Results: Return of spontaneous circulation (ROSC) was gained in 8 (40%) of 20 patients. Maximum rSO2 values were higher in survivorsthan in nonsurvivors (P = 0.005). The mean FOUR score before CA was 11.50 ± 0.8 in survivors, whereas this value was 7.87 ± 0.7 for 1week after ROSC (P < 0.0001). There was a significant positive correlation between the minimum and mean rSO2 values and the mean1-week FOUR scores in survivors (r = 0.811, r = 0.771 and P = 0.015, P = 0.025, respectively).Conclusion: Our results suggest that the maximum rSO2 values affect ROSC while the minimum and mean rSO2 values affect the postcardiac arrest neurological outcome.

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1. Guyton AC, Hall JE. Textbook of Medical Physiology. 11th ed. Philadelphia, PA, USA: Elsevier Inc.; 2006.
2. Safar P. Cerebral resuscitation after cardiac arrest: a review. Circulation 1986; 74: 138-153.
3. Wijdicks EF, Bamlet WR, Maramattom BV, Manno EM, McClelland RL. Validation of a new coma scale: the FOUR score. Ann Neurol 2005; 58: 585-593.
4. Kämäräinen A, Sainio M, Olkkola KT, Huhtala H, Tenhunen J, Hoppu S. Quality controlled manual chest compressions and cerebral oxygenation during in-hospital cardiac arrest. Resuscitation 2012; 8: 138-142.
5. Ferrari M, Mottola L, Quaresima V. Principles, techniques, and limitations of near infrared spectroscopy. Can J Appl Physiol 2004; 29: 463-487.
6. Koyama Y, Wada T, Lohman BD, Takamatsu Y, Matsumoto J, Fujitani S, Taira Y. A new method to detect cerebral blood flow waveform in synchrony with chest compression by nearinfrared spectroscopy during CPR. Am J Emerg Med 2013; 31: 1504-1508.
7. Putzer G, Braun P, Falk M, Paal P, Brugger H, Mair P. NIRS may be a reliable marker of CPR-quality because it correlates with systemic haemodynamics and reflects cerebral oxygenation: 13AP2-8. Eur J Anaesth 2014; 31: 214.
8. Abella BS, Sandbo N, Vassilatos P, Alvarado JP, O’Hearn N, Wigder HN, Hoffman P, Tynus K, Vanden-Hoek TL, Becker LB. Chest compression rates during cardiopulmonary resuscitation are suboptimal: a prospective study during inhospital cardiac arrest. Circulation 2005; 111: 428-434.
9. Herlitz J, Bång A, Alsén B, Aune S. Characteristics and outcome among patients suffering from in hospital cardiac arrest in relation to the interval between collapse and start of CPR. Resuscitation 2002; 53: 21-27.
10. Field JM, Hazinski MF, Sayre MR, Chameides L, Schexnayder SM, Hemphill R, Samson RA, Kattwinkel J, Berg RA, Bhanji F et al. Part 1: Executive summary: 2010 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation 2010; 122: 640.
11. Peberdy MA, Kaye W, Ornato JP, Larkin GL, Nadkarni V, Mancini ME, Berg RA, Nichol G, Trultt TL. Cardiopulmonary resuscitation of adults in the hospital: a report of 14720 cardiac arrests from the National Registry of Cardiopulmonary Resuscitation. Resuscitation 2003; 58: 297-308.
12. Wijdicks EF. The bare essentials: coma. Practical Neurology 2010; 10: 51-60.
13. Nagdyman N, Fleck T, Ewert P, Abdul-Khaliq H, Redlin M, Lange P. Cerebral oxygenation measured by near-infrared spectroscopy during circulatory arrest and cardiopulmonary resuscitation. Brit J Anaesth 2003; 91: 438-442.
14. Andreka P, Frenneaux MP. Haemodynamics of cardiac arrest and resuscitation. Curr Opin Crit Care 2006; 12: 198-203.
15. Reynolds JC, Frisch A, Rittenberger JC, Callaway CW. Duration of resuscitation efforts and functional outcome after out-of-hospital cardiac arrest: when should we change to novel therapies? Circulation 2013; 128: 2488-2494.
16. Kim SJ, Jung JS, Park JH, Park JS, Hong YS, Lee SW. An optimal transition time to extracorporeal cardiopulmonary resuscitation for predicting good neurological outcome in patients with out-of-hospital cardiac arrest: a propensitymatched study. Crit Care 2014; 18: 535.
17. Schewe JC, Thudium MO, Kappler J, Steinhagen F, Eichhorn L, Erdfelder F, Heister U, Ellerkmann R. Monitoring of cerebral oxygen saturation during resuscitation in out-ofhospital cardiac arrest: a feasibility study in a physician staffed emergency medical system. Scand J Trauma Resus 2014; 22: 58.
18. Parnia S, Nasir A, Ahn A, Hanan M, Jie Y, Jiawen Z, Francis D, Paul R. A feasibility study of cerebral oximetry during in-hospital mechanical and manual cardiopulmonary resuscitation. Crit Care Med 2014; 42: 930-933.
19. Phelps R, Dumas F, Maynard C, Silver J, Rea T. Cerebral performance category and long-term prognosis following outof-hospital cardiac arrest. Crit Care Med 2013; 41: 1252-1257.
20. Sanders AB, Kern KB, Berg RA, Hilwig RW, Heidenrich J, Ewy GA. Survival and neurologic outcome after cardiopulmonary resuscitation with four different chest compression-ventilation ratios. Ann Emerg Med 2002; 40: 553-562.
21. Meex I, De Deyne C, Dens J, Scheyltjens S, Lathouwers K, Boer W, Vundelinckx G, Heylen R, Jans F. Feasibility of absolute cerebral tissue oxygen saturation during cardiopulmonary resuscitation. Crit Care 2013; 17: 36.