Kinoshita Kosaku, Sakurai Atsushi, Ihara Shingo
Division of Emergency and Critical Care Medicine, Department of Acute Medicine, Nihon University School of Medicine, 30-1 Oyaguchi Kamimachi Itabashi-ku, Tokyo, 173-8610, Japan.
Scand J Trauma Resusc Emerg Med. 2015 Nov 11;23:95. doi: 10.1186/s13049-015-0173-4.
It remains uncertain whether neuromonitoring reliably predicts outcome in adult post-cardiac arrest patients in the early stage treated with therapeutic hypothermia. Recent reports demonstrated a regional cerebral oxygen saturation of cardiac arrest patients on hospital arrival could predict their neurological outcome. There has been little discussion about the significance of regional cerebral oxygen saturation in patients with post-cardiac arrest syndrome. Amplitude-integrated electroencephalography monitoring may also provide early prognostic information for post-cardiac arrest syndrome. However, even when the initial electroencephalography is flat after the return of spontaneous circulation, good neurological outcome may still be obtainable if the electroencephalography shifts to a continuous pattern. The electroencephalography varied from flat to various patterns, such as flat, epileptic, or continuous during the first 24 h, while regional cerebral oxygen saturation levels varied even when the electroencephalography was flat. It is therefore difficult to estimate whether regional cerebral oxygen saturation accurately indicates the coupling of cerebral blood flow and metabolism in the early stage after cardiac arrest. Careful assessment of prognosis is necessary when relying solely on regional cerebral oxygen saturation as a single monitoring modality.
对于接受治疗性低温治疗的成年心脏骤停后患者，神经监测能否可靠地预测早期预后仍不确定。最近的报告表明，心脏骤停患者入院时的局部脑氧饱和度可预测其神经功能结局。关于心脏骤停后综合征患者局部脑氧饱和度的意义，几乎没有相关讨论。振幅整合脑电图监测也可能为心脏骤停后综合征提供早期预后信息。然而，即使在自主循环恢复后初始脑电图呈平线状态，如果脑电图转变为连续模式，仍可能获得良好的神经功能结局。在最初的24小时内，脑电图从平线状态变化为各种模式，如平线、癫痫样或连续模式，而即使脑电图为平线状态时，局部脑氧饱和度水平也会有所变化。因此，很难估计在心脏骤停后的早期阶段，局部脑氧饱和度是否准确反映了脑血流与代谢的耦合情况。仅依靠局部脑氧饱和度作为单一监测方式时，必须仔细评估预后。
