Abstract

BackgroundPost-cardiac arrest (CA) patients are at risk of secondary ischemic damage in the case of suboptimal brain oxygenation during an ICU stay. We hypothesized that elevated central venous pressures (CVP) would impair cerebral perfusion and oxygenation (venous cerebral congestion). The aim of the present study was to investigate the relationship between CVP, cerebral tissue oxygen saturation (SctO2) as assessed with near-infrared spectroscopy (NIRS) and outcome in post-CA patients.MethodsThis was an observational study in 48 post-CA patients with continuous CVP and SctO2 monitoring during therapeutic hypothermia.ResultsThe relationship between CVP and mean SctO2 was best described by an S-shaped, third-degree polynomial regression curve (SctO2 = −0.002 × CVP3 + 0.08 × CVP2 – 1.07 × CVP + 69.78 %, R2 0.89, n = 1,949,108 data points) with high CVP (>20 mmHg) being associated with cerebral desaturation. Multivariate linear regression revealed CVP to be a more important determinant of SctO2 than mean arterial pressure (MAP) without important interaction between both (SctO2 = 0.01 × MAP – 0.20 × CVP + 0.001 × MAP × CVP + 65.55 %). CVP and cardiac output were independent determinants of SctO2 with some interaction between both (SctO2 = 1.86 × CO – 0.09 × CVP – 0.05 × CO × CVP + 60.04 %). Logistic regression revealed that a higher percentage of time with CVP above 5 mmHg was associated with lower chance of survival with a good neurological outcome (cerebral performance category (CPC) 1–2) at 180 days (OR 0.96, 95 % CI 0.92–1.00, p = 0.04). In a multivariate model, the negative association between CVP and outcome persisted after correction for hemodynamic variables, including ejection fraction and MAP.ConclusionsElevated CVP results in lower brain saturation and is associated with worse outcome in post-CA patients. This pilot study provides support that venous cerebral congestion as indicated by high CVP may be detrimental for post-CA patients.Electronic supplementary materialThe online version of this article (doi:10.1186/s13054-016-1297-2) contains supplementary material, which is available to authorized users.

Highlights

  • Post-cardiac arrest (CA) patients are at risk of secondary ischemic damage in the case of suboptimal brain oxygenation during an ICU stay

  • We previously showed that mean arterial pressure (MAP), mixed venous oxygen saturation, cardiac output, hemoglobin, partial pressure of oxygen (PaO2), and carbon dioxide (PaCO2) are important determinants of cerebral tissue oxygen saturation (SctO2) measured with near-infrared spectroscopy (NIRS) [2,3,4]

  • Cardiac output and filling pressures were continuously monitored with a pulmonary artery catheter in 39 patients and central venous pressures (CVP) was monitored by a deep vein catheter in the remaining 9 patients

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Summary

Introduction

Post-cardiac arrest (CA) patients are at risk of secondary ischemic damage in the case of suboptimal brain oxygenation during an ICU stay. The aim of the present study was to investigate the relationship between CVP, cerebral tissue oxygen saturation (SctO2) as assessed with near-infrared spectroscopy (NIRS) and outcome in post-CA patients. After cardiac arrest (CA), patients with suboptimal brain oxygenation during their stay in the intensive care unit have a large cerebral penumbra and risk of secondary ischemic damage [1]. As it has been shown that there is a good correlation between ICP and central venous pressure (CVP) [6], we hypothesized that there would be negative correlation between CVP and cerebral perfusion (venous cerebral congestion) In this way, cerebral oxygenation might be compromised in after CA, with elevated CVP due to right ventricular failure, fluid overload, mechanical positive pressure ventilation, or pulmonary disease. The aim of the present study was to investigate the relationship between CVP, SctO2 as assessed with near-infrared spectroscopy (NIRS), and outcome after CA in patients under therapeutic hypothermia

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