Abstract
Objective
After cardiac resuscitation, hypoxic encephalopathy often is the limiting factor regarding outcome due to the oxygen sensitivity of the brain. Intracerebral microdialysis is a highly sensitive technique to monitor cerebral energy metabolism and for the early detection of cerebral hypoxia.
Patient and interventions
A 34-year-old male patient who had to be craniectomized due to a mass demanding middle cerebral artery infarct. A microdialysis catheter was inserted into the left frontal lobe and, as control, into the abdominal subcutaneous adipose tissue. Pulmonary embolism and asystolia leading to cardiac resuscitation occurred.
Measurements and results
The cerebral chemical markers of energy metabolism glucose, lactate, pyruvate, and the marker of cell membrane damage glycerol were measured. Except for subcutaneous glucose, all markers showed a sudden and significant increase during resuscitation and a prolonged period afterwards. After some hours all values returned to normal.
Conclusion
This is the first reported case of monitoring neurochemical markers using intracerebral microdialysis during cardiac resuscitation. The findings indicate the importance of early and efficient resuscitation and demonstrate that deviations in cerebral energy metabolism are reversible.
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References
Vaagenes P, Ginsberg M, Ebmeyer U, Ernster L, Fischer M, Gisvold SE, Gurvitch A, Hoosmann KA, Nemoto EM, Radovsky A, Severinghaus JW, Safar P, Schlichtig R, Sterz F, Tonnessen T, White RJ, Xiao F, Zhou Y (1996) Cerebral resuscitation from cardiac arrest. Critical Care Med Supplement 24:57S-68S
Peerdeman SM, Girbes ARJ, Vandertop WP (2000) Cerebral microdialysis as a new tool for neurometabolic monitoring ( review). Intensive Care Med 26:662–669
Hutchinson PJ, O’Conell MT, Al-Rawi PG, Maskell LB, Kett-White R, Gupta AK, Richards HK, Hutchinson DB, Kirkpatrick PJ, Pickard JD (2000) Clinical cerebral microdialysis: a methodological study. J Neurosurg 93:37–43
Stahl N, Mellergard P, Hallström A, Ungerstedt U, Nordström CH (2001) Intracerebral microdialysis and bedside biochemical analysis in patients with fatal traumatic brain lesions. Acta Anaesthesiol Scand 45:977–985
Hutchinson PJA, Al-Rawi PG, O’Conell MT, Gupta AK, Maskell LB, Hutchinson DBA, Pickard JD, Kirkpatrick PJ (2001) Head injury monitoring using cerebral microdialysis and Paratrend multiparameter sensors. Zentralblatt für Neurochirurgie 61:88–94
Zauner A, Doppenberg EMR, Woodward JJ, Choi SC, Young HF, Bullock R (1997) Continuous monitoring of cerebral substrate delivery and clearance: initial experience in 24 patients with severe acute brain injuries. Neurosurgery 41:1082–1093
Schulz MK, Wang LP, Tange M, Bjerre P (2000) Cerebral microdialysis monitoring: determination of normal and ischemic cerebral metabolisms in patients with aneurysmal subarachnoid hemorrhage. J Neurosurg 93:808–814
Persson L, Valtysson J, Enblad P, Wärme PE, Cesarini K, Lewen A, Hillered L (1996) Neurochemical monitoring using intracerebral microdialysis in patients with subarachnoid hemorrhage. J Neurosurgery 84:606–616
Unterberg AW, Sakowitz OW, Sarrafzadeh AS, Benndorf G, Lanksch WR (2001) Role of bedside microdialysis in the diagnosis of cerebral vasospasm following aneurysmal subarachnoid hemorrhage. J Neurosurgery 94:740–749
Sarrafzadeh AS, Sakowitz OW, Lanksch WR, Unterberg AW (2001) Time course of various interstitial metabolites following subarachnoid hemorrhage studied by on-line microdialysis. Acta Neurochir Suppl 77:145–147
Erecinska M, Silver IA (2001) Tissue oxygen tension and brain sensitivity to hypoxia. Respir Physiol 128:263–276
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Bauer, R., Gabl, M., Obwegeser, A. et al. Neurochemical monitoring using intracerebral microdialysis during cardiac resuscitation. Intensive Care Med 30, 159–161 (2004). https://doi.org/10.1007/s00134-003-2015-5
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DOI: https://doi.org/10.1007/s00134-003-2015-5