Background The aim of the present study was to evaluate cerebral metabolism monitoring during therapeutic hypothermia for global ischemic brain damage after cardiopul-monary resuscitation (CPR).
Methods Jugular venous sampling and positron emission tomography (PET) were used. Seven comatose patients with cardiopulmonary arrest underwent hypothermia treatment as soon as possible after CPR. The body temperature of these patients was maintained at 34°C for 72 h. Rewarming was performed at a rate of 1°C/day. To monitor jugular venous saturation (SjO2) and lactate (lac-JV), a fiberoptic catheter was inserted into the jugular bulb. Oxygen extraction fraction (OEF) was calculated using the difference between arterial oxygen saturation (SaO2) and SjO2. 18F-fluorodeoxyglucose (FDG) PET was per- formed to investigate cerebral glucose metabolism at the end of therapeutic hypothermia.
Findings The OEF was significantly increased at the end of hypothermia in four patients with favorable outcome on the Glasgow Outcome Scale (hypothermia onset 15.3±2.0% vs. hypothermia end 30.3±2.8%, P<0.05). In three patients with unfavourable outcome (severe or worse on the Glasgow Outcome Scale), end hypothermia OEF tended to be low. There was also a reduction in FDG uptake in these three patients with unfavourable outcome. The lac-JV was significantly decreased at the end of hypothermia treatment compared with hypothermia onset (27.7±7.4 vs. 6.0±3.0 mg/dL, P<0.05).
Conclusions The measurement of cerebral metabolism parameters, especially OEF, might be useful for estimation of hypothermia therapy in patients with unconsciousness after resuscitation after cardiac arrest.
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References
Bernard SA, Gray TW, Buist MD, Jones BM, Silvester W, Gutteridge G, Smith K (2002) Treatment of comatose survivors of out-of-hospital cardiac arrest with induced hypothermia. N Engl J Med 346:557–563
Cruz J, Raps EC, Hoffstad OJ, Jaggi JL, Gennarelli TA (1993) Cerebral oxygenation monitoring. Crit Care Med 21:1242–1246
Donnino MW, Miller J, Goyal N, Loomba M, Sankey SS, Dolcourt B, Sherwin R, Otero R, Wira C (2007) Effective lactate clearance is associated with improved outcome in post-cardiac arrest patients. Resuscitation 75(2):229–234
The Hypothermia After Cardiac Arrest Study Group (2002) Mild therapeutic hypothermia to improve the neurologic outcome after cardiac arrest. N Engl J Med 346:549–556
Kawai N, Miyake K, Nishiyama Y, Yamamoto Y, Sasakawa Y, Haba R, Kushida Y, Tamiya T, Nagao S (2006) FDG-PET findings of the brain in lymphomatoid granulomatosis. Ann Nucl Med 20:683–687
Minima T, Ogawa M, Sugimoto T, Katsurada K (1973) Hyperoxia of internal jugular venous blood in brain death. J Neurosurg 39:442–444
Nakamura T, Nagao S, Kawai N, Honma Y, Kuyama H (1998) Significance of multimodal cerebral monitoring under therapeutic hypothermia severe head injury. Acta Neurochir Suppl 71:85–87
Nakamura T, Miyamoto O, Yamagami S, Hayashida Y, Itano T, Nagao S (1999) Influence of rewarming conditions after hypothermia in gerbils with transient forebrain ischemia. J Neurosurg 91:114–120
Nakamura T, Tatara N, Morisaki K, Kawakita K, Nagao S (2002) Cerebral oxygen metabolism monitoring under hypothermia for severe subarachnoid hemorrhage: report of eight cases. Acta Neurol Scand 106:314–318
Takasu A, Yagi K, Ishihara S, Okada Y (1995) Combined continuous monitoring of systemic and cerebral oxygen metabolism after cardiac arrest. Resuscitation 29:189–194
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Nakamura, T. et al. (2008). Cerebral metabolism monitoring during hypothermia following resuscitation from cardiopulmonary arrest. In: Steiger, H.J. (eds) Acta Neurochirurgica Supplements. Acta Neurochirurgica Supplementum, vol 102. Springer, Vienna. https://doi.org/10.1007/978-3-211-85578-2_40
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