Meex Ingrid, De Deyne Cathy, Dens Jo, Scheyltjens Simon, Lathouwers Kevin, Boer Willem, Vundelinckx Guy, Heylen René, Jans Frank
Crit Care. 2013 Mar 1;17(2):R36. doi: 10.1186/cc12546.
Current monitoring during cardiopulmonary resuscitation (CPR) is limited to clinical observation of consciousness, breathing pattern and presence of a pulse. At the same time, the adequacy of cerebral oxygenation during CPR is critical for neurological outcome and thus survival. Cerebral oximetry, based on near-infrared spectroscopy (NIRS), provides a measure of brain oxygen saturation. Therefore, we examined the feasibility of using NIRS during CPR.
Recent technologies (FORE-SIGHT™ and EQUANOX™) enable the monitoring of absolute cerebral tissue oxygen saturation (SctO2) values without the need for pre-calibration. We tested both FORE-SIGHT™ (five patients) and EQUANOX Advance™ (nine patients) technologies in the in-hospital as well as the out-of-hospital CPR setting. In this observational study, values were not utilized in any treatment protocol or therapeutic decision. An independent t-test was used for statistical analysis.
Our data demonstrate the feasibility of both technologies to measure cerebral oxygen saturation during CPR. With the continuous, pulseless near-infrared wave analysis of both FORE-SIGHT™ and EQUANOX™ technology, we obtained SctO2 values in the absence of spontaneous circulation. Both technologies were able to assess the efficacy of CPR efforts: improved resuscitation efforts (improved quality of chest compressions with switch of caregivers) resulted in higher SctO2 values. Until now, the ability of CPR to provide adequate tissue oxygenation was difficult to quantify or to assess clinically due to a lack of specific technology. With both technologies, any change in hemodynamics (for example, ventricular fibrillation) results in a reciprocal change in SctO2. In some patients, a sudden drop in SctO2 was the first warning sign of reoccurring ventricular fibrillation.
Both the FORE-SIGHT™ and EQUANOX™ technology allow non-invasive monitoring of the cerebral oxygen saturation during CPR. Moreover, changes in SctO2 values might be used to monitor the efficacy of CPR efforts.
当前心肺复苏（CPR）期间的监测仅限于对意识、呼吸模式和脉搏的临床观察。与此同时，CPR期间脑氧合是否充足对于神经功能转归乃至存活至关重要。基于近红外光谱（NIRS）的脑氧饱和度测定法可提供脑氧饱和度的测量值。因此，我们研究了在CPR期间使用NIRS的可行性。
最新技术（FORE-SIGHT™和EQUANOX™）能够在无需预先校准的情况下监测绝对脑组织氧饱和度（SctO2）值。我们在院内及院外CPR环境中对FORE-SIGHT™（5例患者）和EQUANOX Advance™（9例患者）技术进行了测试。在这项观察性研究中，这些值未用于任何治疗方案或治疗决策。采用独立t检验进行统计分析。
我们的数据证明了这两种技术在CPR期间测量脑氧饱和度的可行性。通过对FORE-SIGHT™和EQUANOX™技术进行连续、无脉搏的近红外波分析，我们在无自主循环的情况下获得了SctO2值。这两种技术均能够评估CPR的效果：复苏效果改善（更换施救者后胸外按压质量提高）会导致SctO2值升高。到目前为止，由于缺乏特定技术，CPR提供充足组织氧合的能力难以进行量化或临床评估。使用这两种技术时，任何血流动力学变化（例如室颤）都会导致SctO2发生相应变化。在一些患者中，SctO2突然下降是室颤复发的首个警示信号。
FORE-SIGHT™和EQUANOX™技术均允许在CPR期间对脑氧饱和度进行无创监测。此外，SctO2值的变化可用于监测CPR的效果。
