Abstract
Cerebral protection against secondary hypoxic-ischemic brain injury is a key priority area in post-resuscitation intensive care management in survivors of cardiac arrest. Nevertheless, the current understanding of the incidence, diagnosis and its’ impact on neurological outcome remains undetermined. The aim of this study was to evaluate jugular bulb oximetry as a potential monitoring modality to detect the incidences of desaturation episodes during post-cardiac arrest intensive care management and to evaluate their subsequent impact on neurological outcome. We conducted a prospective, observational study in unconscious adult patients admitted to the intensive care unit who had successful resuscitation following out of hospital cardiac arrest of presumed cardiac causes. All the patients were treated as per European Resuscitation Council 2015 guidelines and they received jugular bulb catheter. Jugular bulb oximetry measurements were performed at six hourly intervals. The neurological outcomes were evaluated on 90th day after the cardiac arrest by cerebral performance categories scale. Forty patients met the eligibility criteria. Measurements of jugular venous oxygen saturation were performed for 438 times. Altogether, we found 2 incidences of jugular bulb oxygen saturation less than 50% (2/438; 0.46%), and 4 incidences when it was less than 55% (4/438; 0.91%). The study detected an association between SjVO2 and CO2 (r = 0.26), each 1 kPa increase in CO2 led to an increase in SjvO2 by 3.4% + / − 0.67 (p < 0.0001). There was no association between SjvO2 and PaO2 or SjvO2 and MAP. We observed a statistically significant higher mean SjvO2 (8.82% + / − 2.05, p < 0.0001) in unfavorable outcome group. The episodes of brain hypoxia detected by jugular bulb oxygen saturation were rare during post-resuscitation intensive care management in out of hospital cardiac arrest patients. Therefore, this modality of monitoring may not yield any additional information towards prevention of secondary hypoxic ischemic brain injury in post cardiac arrest survivors. Other factors contributing towards high jugular venous saturation needs to be considered.
Highlights
About 1 in 1000 people experience out of hospital cardiac arrest (OHCA), of which about 25% survive to hospital admission and only 10% survive until hospital discharge [1]
Fourteen of them were excluded, as they did not meet the inclusion criteria (8 died within 72 h due to refractory post CA shock, 3 were found to have a non-cardiac cause of CA, 1 had intracranial bleeding after sustaining a fall following OHCA, in 1 patient jugular bulb catheter could not be inserted, 1 had accidental removal of the jugular bulb catheter during X ray)
SjvO2 measurements were performed 438 times (Table 3). SjvO2 values of less than 50% were detected twice (2/438; 0.46%) in 2 different patients (1 had favorable and the other had unfavorable outcome); whereas SjvO2 values of less than 55% were detected 4 times (4/438; 0.91%) in 3 different patients (2 had favorable and 1 had unfavorable outcome) (Table 3)
Summary
About 1 in 1000 people experience out of hospital cardiac arrest (OHCA), of which about 25% survive to hospital admission and only 10% survive until hospital discharge [1]. The most common cause of death in OHCA patients who survive to intensive care unit (ICU) admission is severe neurological injury which is a summation of primary and secondary hypoxic ischemic brain injuries, HIBI [2, 3]. The primary HIBI is caused by cessation of cerebral blood flow during the. There is a period characterized by an imbalance between cerebral oxygen demand and cerebral oxygen delivery which may occur within minutes, hours or days after ROSC. The cerebral protection strategies against secondary HIBI remains the key priority of post-cardiac arrest (post-CA) ICU management
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