Cerebral Oximetry During Prolonged Cardiac Arrest and Percutaneous Coronary Intervention

Abstract

Objective. To evaluate the feasibility of cerebral oximetry (SctO2) with arterial blood pressure (ABP), central venous pressure (CVP), end tidal carbon dioxide (ETCO2), pulse oximetry (SpO2), and arterial blood gases during resuscitation in the coronary catheterization laboratory (cath-lab) setting. Design. We have implemented SctO2 in our cath-lab when cardiac arrest patients are in the need of prolonged resuscitation efforts with mechanical chest compressions (MCC) during simultaneous percutaneous coronary intervention (PCI). Setting. An academic coronary catheterization laboratory. Patients. Five cardiac arrest patients required prolonged resuscitation efforts with MCC in the cath-lab during simultaneous PCI. Results. During MCC, median SctO2 (n = 5) was 47%, median systolic ABP (n = 5) was 88 mm Hg, mean ABP (n = 5) was 58 mm Hg, coronary perfusion pressure (n = 3) was 19 mm Hg, SpO2 (n = 4) was 81%, and ETCO2 (n = 4) was 18.8 torr (2.5 kPa). Four patients had a successful PCI, including 1 patient with a pericardial drainage for cardiac tamponade during MCC. Mean treatment time of MCC in the cath-lab was 50.8 ± 28.3 minutes (median = 45 minutes, range = 12-90 minutes). Two patients obtained return of spontaneous circulation (ROSC). They died in the ICU due to impaired circulation and multiorgan failure, after 32 and 60 hours, respectively. Conclusion. Cerebral oximetry seems to be a feasible noninvasive parameter in assessing the perfusion and oxygenation of the brain in cardiac arrest patients receiving chest compressions during simultaneous PCI. Further studies are needed to evaluate its use in resuscitation situations to predict ROSC, quality of cardiopulmonary resuscitation, and neurologic outcome.