一项探讨以区域性脑氧饱和度监测作为休克（VF/VT）和非休克（PEA/心搏停止）心搏骤停病因自主循环恢复标志物的初步研究。
A pilot study examining the role of regional cerebral oxygen saturation monitoring as a marker of return of spontaneous circulation in shockable (VF/VT) and non-shockable (PEA/Asystole) causes of cardiac arrest.
机构信息
Resuscitation Research Group, State University of New York at Stony Brook, Stony Brook University Hospital, T17-040 Health Sciences Center, Stony Brook NY 11794-8172, NY, USA.
出版信息
Resuscitation. 2013 Dec;84(12):1713-6. doi: 10.1016/j.resuscitation.2013.07.026. Epub 2013 Aug 12.
BACKGROUND
Non-invasive monitoring of cerebral perfusion and oxygen delivery during cardiac arrest is not routinely utilized during cardiac arrest resuscitation. The objective of this study was to investigate the feasibility of using cerebral oximetry during cardiac arrest and to determine the relationship between regional cerebral oxygen saturation (rSO2) with return of spontaneous circulation (ROSC) in shockable (VF/VT) and non-shockable (PEA/asystole) types of cardiac arrest.
METHODS
Cerebral oximetry was applied to 50 in-hospital and out-of-hospital cardiac arrest patients.
RESULTS
Overall, 52% (n=26) achieved ROSC and 48% (n=24) did not achieve ROSC. There was a significant difference in mean±SD rSO2% in patients who achieved ROSC compared to those who did not (47.2±10.7% vs. 31.7±12.8%, p<0.0001). This difference was observed during asystole (median rSO2 (IQR) ROSC versus no ROSC: 45.0% (35.1-48.8) vs. 24.9% (20.5-32.9), p<0.002) and PEA (50.6% (46.7-57.5) vs. 31.6% (18.8-43.3), p=0.02), but not in the VF/VT subgroup (43.7% (41.1-54.7) vs. 42.8% (34.9-45.0), p=0.63). Furthermore, it was noted that no subjects with a mean rSO2<30% achieved ROSC.
CONCLUSIONS
Cerebral oximetry may have a role as a real-time, non-invasive predictor of ROSC during cardiac arrest. The main utility of rSO2 in determining ROSC appears to apply to asystole and PEA subgroups of cardiac arrest, rather than VF/VT. This observation may reflect the different physiological factors involved in recovery from PEA/asytole compared to VF/VT. Whereas in VF/VT, successful defibrillation is of prime importance, however in PEA and asytole achieving ROSC is more likely to be related to the quality of oxygen delivery. Furthermore, a persistently low rSO2 <30% in spite of optimal resuscitation methods may indicate futility of resuscitation efforts.
背景
在心脏骤停复苏期间，并未常规使用非侵入性监测脑灌注和氧输送。本研究的目的是探讨在心脏骤停期间使用脑氧饱和度监测的可行性，并确定区域脑氧饱和度（rSO2）与可电击性（VF/VT）和非可电击性（PEA/心搏停止）心脏骤停类型之间的关系。
方法
对 50 例院内和院外心脏骤停患者应用脑氧饱和度监测。
结果
总体而言，有 52%（n=26）的患者实现了自主循环恢复，48%（n=24）的患者未实现自主循环恢复。与未实现自主循环恢复的患者相比，实现自主循环恢复的患者的平均 rSO2%有显著差异（47.2±10.7% vs. 31.7±12.8%，p<0.0001）。这种差异在心搏停止时观察到（中位数 rSO2（IQR）自主循环恢复与未恢复：45.0%（35.1-48.8）vs. 24.9%（20.5-32.9），p<0.002）和 PEA（50.6%（46.7-57.5）vs. 31.6%（18.8-43.3），p=0.02），但在 VF/VT 亚组中没有观察到（43.7%（41.1-54.7）vs. 42.8%（34.9-45.0），p=0.63）。此外，还注意到，平均 rSO2<30%的患者无一例实现了自主循环恢复。
结论
脑氧饱和度监测可能成为心脏骤停期间自主循环恢复的实时、非侵入性预测指标。rSO2 确定自主循环恢复的主要用途似乎适用于心脏骤停的心搏停止和 PEA 亚组，而不适用于 VF/VT。这一观察结果可能反映了与 VF/VT 相比，PEA/心搏停止从心脏骤停中恢复涉及的不同生理因素。在 VF/VT 中，成功除颤是最重要的，但在 PEA 和心搏停止中，实现自主循环恢复更可能与氧输送的质量有关。此外，尽管采用了最佳的复苏方法，但持续的低 rSO2<30%可能表明复苏努力的无效。
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