Department of Surgical Sciences - Anaesthesiology & Intensive Care, Uppsala University, Uppsala, Sweden.
Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, University of Gävle, Gävle, Sweden.
Acta Anaesthesiol Scand. 2018 Oct;62(9):1237-1245. doi: 10.1111/aas.13162. Epub 2018 May 24.
Using cerebral oxygen venous saturation post-cardiac arrest (CA) is limited because of a small sample size and prior to establishment of target temperature management (TTM). We aimed to describe variations in jugular bulb oxygen saturation during intensive care in relation to neurological outcome at 6 months post- CA in cases where TTM 33°C was applied.
Prospective observational study in patients over 18 years, comatose immediately after resuscitation from CA. Patients were treated with TTM 33°C M and received a jugular bulb catheter within the first 26 hours post-CA. Neurological outcome was assessed at 6 months using the Cerebral Performance Categories (CPC) and dichotomized into good (CPC 1-2) and poor outcome (CPC 3-5).
Seventy-five patients were included and 37 (49%) patients survived with a good outcome at 6 months post-CA. No differences were found between patients with good outcome and poor outcome in jugular bulb oxygen saturation. Higher values were seen in differences in oxygen content between central venous oxygen saturation and jugular bulb oxygen saturation in patients with good outcome compared to patients with poor outcome at 6 hours (12 [8-21] vs 5 [-0.3 to 11]% P = .001) post-CA. Oxygen extraction fraction from the brain illustrated lower values in patients with poor outcome compared to patients with good outcome at 96 hours (14 [9-23] vs 31 [25-34]% P = .008).
Oxygen delivery and extraction differed in patients with a good outcome compared to those with a poor outcome at single time points. Based on the present findings, the usefulness of jugular bulb oxygen saturation for prognostic purposes is uncertain in patients treated with TTM 33°C post-CA.
由于样本量小且在目标温度管理（TTM）建立之前，使用心脏骤停后（CA）的脑氧静脉饱和度存在局限性。我们旨在描述在应用 TTM 33°C 的情况下，6 个月后 CA 患者在重症监护期间颈静脉球血氧饱和度的变化与神经预后的关系。
这是一项前瞻性观察性研究，纳入了年龄在 18 岁以上、从 CA 复苏后立即昏迷的患者。患者接受 TTM 33°C 治疗，在 CA 后 26 小时内接受颈静脉球导管。6 个月后使用脑功能分类（CPC）评估神经预后，并分为良好（CPC 1-2）和不良（CPC 3-5）结局。
共纳入 75 例患者，37 例（49%）患者在 CA 后 6 个月存活且预后良好。预后良好与预后不良患者之间的颈静脉球血氧饱和度无差异。在 CA 后 6 小时，与预后不良患者相比，预后良好患者的中心静脉血氧饱和度与颈静脉球血氧饱和度之间的氧含量差异较大（12 [8-21]%比 5 [-0.3 至 11]%，P =.001）。在 CA 后 96 小时，脑氧摄取分数在预后不良患者中低于预后良好患者（14 [9-23]%比 31 [25-34]%，P =.008）。
在单个时间点，预后良好的患者与预后不良的患者相比，氧输送和摄取存在差异。基于目前的发现，在接受 TTM 33°C 治疗的 CA 患者中，颈静脉球血氧饱和度用于预后目的的效用尚不确定。
