All authors: Department of Medicine, State University of New York at Stony Brook, Stony Brook Medical Center, Stony Brook, NY.
Crit Care Med. 2018 May;46(5):757-763. doi: 10.1097/CCM.0000000000003014.
To date, no studies have examined real-time electroencephalography and cerebral oximetry monitoring during cardiopulmonary resuscitation as markers of the magnitude of global ischemia. We therefore sought to assess the feasibility of combining cerebral oximetry and electroencephalography in patients undergoing cardiopulmonary resuscitation and further to evaluate the electroencephalography patterns during cardiopulmonary resuscitation and their relationship with cerebral oxygenation as measured by cerebral oximetry.
Extended case series of in-hospital and out-of-hospital cardiac arrest subjects.
Tertiary Medical Center.
Inclusion criteria: Convenience sample of 16 patients undergoing cardiopulmonary resuscitation during working hours between March 2014 and March 2015, greater than or equal to 18 years. A portable electroencephalography (Legacy; SedLine, Masimo, Irvine, CA) and cerebral oximetry (Equanox 7600; Nonin Medical, Plymouth, MN) system was used to measure cerebral resuscitation quality.
Real-time regional cerebral oxygen saturation and electroencephalography readings were observed during cardiopulmonary resuscitation. The regional cerebral oxygen saturation values and electroencephalography patterns were not used to manage patients by clinical staff.
In total, 428 electroencephalography images from 16 subjects were gathered; 40.7% (n = 174/428) were artifactual, therefore 59.3% (n = 254/428) were interpretable. All 16 subjects had interpretable images. Interpretable versus noninterpretable images were not related to a function of time or duration of cardiopulmonary resuscitation but to artifacts that were introduced to the raw data such as diaphoresis, muscle movement, or electrical interference. Interpretable data were able to be obtained immediately after application of the electrode strip. Seven distinct electroencephalography patterns were identified. Voltage suppression was commonest and seen during 78% of overall cardiopulmonary resuscitation time and in 15 of 16 subjects at some point during their cardiopulmonary resuscitation. Other observed patterns and their relative prevalence in relation to overall cardiopulmonary resuscitation time were theta background activity 8%, delta background activity 5%, bi frontotemporal periodic discharge 4%, burst suppression 2%, spike and wave 2%, and rhythmic delta activity 1%. Eight of 16 subjects had greater than one interpretable pattern. At regional cerebral oxygen saturation levels less than or equal to 19%, the observed electroencephalography pattern was exclusively voltage suppression. Delta background activity was only observed at regional cerebral oxygen saturation levels greater than 40%. The remaining patterns were observed throughout regional cerebral oxygen saturation categories above a threshold of 20%.
Real-time monitoring of cerebral oxygenation and function during cardiac arrest resuscitation is feasible. Although voltage suppression is the commonest electroencephalography pattern, other distinct patterns exist that may correlate with the quality of cerebral resuscitation and oxygen delivery.
迄今为止，尚无研究探讨心肺复苏期间实时脑电图和脑氧饱和度监测作为评估整体缺血程度的标志物。因此，我们旨在评估在心肺复苏过程中联合使用脑氧饱和度和脑电图的可行性，并进一步评估心肺复苏期间的脑电图模式及其与脑氧饱和度的关系。
院内和院外心脏骤停患者的扩展病例系列。
三级医疗中心。
纳入标准：2014 年 3 月至 2015 年 3 月期间工作时间内接受心肺复苏的 16 例方便样本患者，年龄大于或等于 18 岁。使用便携式脑电图（Legacy；SedLine，Masimo，Irvine，CA）和脑氧饱和度（Equanox 7600；Nonin Medical，Plymouth，MN）系统来测量脑复苏质量。
在心肺复苏过程中实时观察局部脑氧饱和度和脑电图读数。临床工作人员未使用局部脑氧饱和度值和脑电图模式来管理患者。
共采集了 16 名患者的 428 张脑电图图像；40.7%（n=174/428）为伪迹，因此 59.3%（n=254/428）为可解释。所有 16 名患者都有可解释的图像。可解释的图像与时间或心肺复苏持续时间的函数无关，但与原始数据中的伪迹有关，如出汗、肌肉运动或电干扰。电极条应用后即可立即获得可解释的数据。确定了七种不同的脑电图模式。电压抑制最常见，在整个心肺复苏期间出现 78%，在 16 名患者中的 15 名患者在其心肺复苏过程中的某个时间点出现。其他观察到的模式及其与整个心肺复苏时间的相对发生率为θ背景活动 8%，δ背景活动 5%，双额颞部周期性放电 4%，爆发抑制 2%，棘波和尖波 2%，节律性δ活动 1%。16 名患者中有 8 名患者有大于一种可解释的模式。在局部脑氧饱和度水平等于或小于 19%时，观察到的脑电图模式为电压抑制。仅在局部脑氧饱和度水平大于 40%时观察到δ背景活动。其余模式在局部脑氧饱和度阈值以上的 20%以上的分类中均可见。
在心脏骤停复苏期间实时监测脑氧合和功能是可行的。尽管电压抑制是最常见的脑电图模式，但还存在其他明显的模式，可能与脑复苏和氧输送质量相关。
