Abstract
Objective
To assess the usefulness of differences in oxygen content between mixed venous blood and cerebral venous blood for predicting neurological outcome after cardiac arrest.
Design
Observational study.
Setting
Medical-surgical intensive care unit (IUC) in a university hospital.
Patients and participants
34 acutely comatose patients who had been admitted to the ICU after cardiac arrest and successful cardiopulmonary resuscitation, classified according to outcome (group A, brain death; group B, vegetative state; group C, neurological recovery).
Measurements and results
Between 6 and 18h (mean 12±16.3 h) after hemodynamic stability and 24h later, the patient's neurological status was assessed by means of the Glasgow Coma Scale and blood gas analysis, partial pressure of O2, oxygen content in venous blood from the jugular bulb and mixed venous blood, O2 saturation, and lactate and creatine kinase activity (CK) in CSF were determined. Group C patients had significantly lower lactate and CK levels in CSF as compared with patients in groups A and B. Mean oxygen content in mixed venous blood was higher than that in cerebral venous blood in group C patients, whereas the opposite was found in patients with unfavourable outcome. A positive difference in oxygen content between mixed venous blood and cerebral venous blood showed a sensitivity of 95%, specificity of 100%, positive predictive value of 100%, and negative predictive value of 92% for predicting recovery of consciousness.
Conclusions
Differences between oxygen content of blood samples from the pulmonary artery and the jugular bulb is a simple measurement that has provided good accuracy in the outcome prediction of brain damage after cardiac arrest treated by resuscitation.
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References
Edgren E, Hedstrand ULF, Nodin M, Rydin E, Ronquist G (1987) Prediction of outcome after cardiac arrest. Crit Care Med 15:820–825
Bertini G, Margheri M, Cricelli I, Simone de L, Taddei T, Marchionni N, Zini G, Gensini GI (1989) Prognostic significance of early clinical manifestations in resuscitated after prehospital cardiac arrest. Crit Care Med 17:627–633
Cerebral Resuscitation Study Group of the Belgian Society for Intensive Care (1988) Predictive value of Glasgow coma score for awakening after out-of-hospital cardiac arrest. Lancet 1:137–140
Scollo-Lavizzari G, Bassetti C (1987) Prognostic value of EEG in post-anixic coma after cardiac arrest. Eur Neurol 26:161–170
Austin EJ, Wilkus RJ, Longstreth WT Jr (1988) Etiology and prognosis of alpha coma. Neurology 38:773–777
Brunco E, Zegers de Beyl D (1987) Prognostic value of early cortical somatogsensory evoked potentials after resuscitation from cardiac arrest. Electroencephalogr Clin Neurophysiol 66:15–24
Beckstead JE, Tweed WA, Lee J, MacKeen WL (1978) Cerebral blood flow and metabolism in man following cardiac arrest. Stroke 9:569–573
Obrist WD, Langfitt TW, Jaggi JL, Cruz J, Gennarelli TA (1984) Cerebral blood flow and metabolism in comatose patients with acute head injury. Relationship to intracranial hypertension. J Neurosurg 61:241–253
Ducassé J-L, Marc-Vergnes J-P, Cathala B, Genestal M, Lareng L (1984) Early cerebral prognosis of anoxic encephalopathy using brain energy metabolism. Crit Care Med 12:897–900
Frewen TC, Sumabat WO, Del Maestro RF (1985) Cerebral blood flow, metabolic rate, and cross-brain oxygen consumption in brain injury. J Pediatr 107:510–513
Gayle M, Frewen TC (1987) Brain oxygen extraction and outcome following hypoxic ischemic brain injury in children [abstract]. Crit Care Med 15:418
Cold GE (1986) The relationship between cerebral metabolic rate of oxygen and cerebral blood flow in the acute phase of head injury. Acta Anaesthesiol Scand 30:453–457
Bes A, Marc-Vergns JP, Escande M, Lareng L (1970) Cerebral blood flow and metabolism in three types of coma: apopletic coma, barbituric coma, coma depassé. In: Rusell JR (ed) Brain and blood flow, Pitman, London, p 138
Odin KJ, Karkela J, Thissen JT, Marnela KM (1989) Biogenic amine metabolites in human CSF after hypoxia due to cardiac arrest. Acta Neurol Scand 80:6–11
Chandler WL, Clayson KJ, Longstreth WT Jr, Fine JS (1986) Mitochondrial and MB isoenzymes of creatine kinase in cerebrospinal fluid from patients with hypoxic-ischemic brain damage. Am J Clin Pathol 86:533–537
Vaagenes P, Safar P, Diven W, Moosy J, Rao G, Cantadore R, Kelsey S (1988) Brain enzyme levels in CSF after cardiac arrest and resuscitation in dogs: markers of damage and predictors of outcome. J Cereb Blood Metab 8:262–275
Goe M, Massey TH (1988) Assessment of neurologic damage: creatine kinase-BB assay after cardiac arrest. Heart Lung 17:247–253
Kärkelä J, Pasanen M, Kaukinen S, Mörsky P, Harmoinen A (1992) Evaluation of hypoxic brain injury with spinal fluid enzymes, lactate, and pyruvate. Crit Care Med 20:378–386
Goetting MG, Preston G (1990) Jugular bulb catheterization: experience with 123 patients. Crit Care Med 18:1220–1223
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Zarzuelo, R., Castañeda, J. Differences in oxygen content between mixed venous blood and cerebral venous blood for outcome prediction after cardiac arrest. Intensive Care Med 21, 71–75 (1995). https://doi.org/10.1007/BF02425158
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DOI: https://doi.org/10.1007/BF02425158