Short communicationQuality controlled manual chest compressions and cerebral oxygenation during in-hospital cardiac arrest☆
Introduction
High quality of cardiopulmonary resuscitation (CPR) is associated with the successful return of spontaneous circulation (ROSC),1 cerebral perfusion2 and cerebral oxygenation.3 Quality monitoring may be important also during CPR performed by health care professionals.4
Contemporary defibrillators enable real time CPR quality analysis. Although CPR aims to minimize ischaemic injury, currently there are limited techniques to quantify cerebral perfusion during CPR. We sought to evaluate whether CPR quality is reflected in cerebral oxygenation as a surrogate for cerebral perfusion.
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Materials and methods
The study protocol was approved by the ethics committee of Tampere University Hospital (clinicaltrials.gov: NCT00951704). Following informed written consent from the next of kin, cardiac arrest patients in the Tampere University Hospital treated by a medical emergency team (MET) were enrolled (14 month period from November 2008 to January 2010). Exclusion criteria were age <18 years and unavailability of a dedicated study nurse for cerebral oximetry monitoring.
The MET is equipped with a Philips
Results
Nine patients were included – the mean age of the 6 female and 3 male patients was 80 years. The initial cardiac rhythm was pulseless electrical activity in 5 (56%), asystole in 3 (33%) and pulseless ventricular tachycardia in 1 (11%) patient (Table 1).
The median delay for the MET to initiate CPR after the onset of cardiac arrest was 2 min 25 s (2 min 2 s–2 min 35 s). The duration of a quality controlled resuscitation attempt was 6 min 42 s (4 min 40 s–7 min 18 s), during which 620 (451–721) compressions
Discussion
The main finding was that cerebral oxygenation remained low throughout high quality resuscitation. This is contradictory to previous reports which have demonstrated that during cardiac surgery cerebral rSO2 decreases in circulatory arrest but increases during CPR7 or cardiopulmonary bypass.8 Herein, a marked increase in cerebral oxygenation was observed just prior to ROSC and it remained at a higher level thereafter. To our knowledge this is the first report from a small series of patients with
Conclusions
During in-hospital cardiac arrest and high quality CPR, frontal cerebral rSO2 remained low until return of spontaneous circulation. Improving CPR technique after a brief episode of substandard CPR was not significantly reflected in NIRS. Other factors than currently appreciated quality indicators of CPR alone are associated with adequate cerebral perfusion.
Conflicts of interest
None to declare.
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Comparison of chest compression quality between the overlapping hands and interlocking hands techniques: A randomised cross-over trial
2023, American Journal of Emergency MedicineComparison of manual and mechanical chest compression techniques using cerebral oximetry in witnessed cardiac arrests at the emergency department: A prospective, randomized clinical study
2021, American Journal of Emergency MedicineCitation Excerpt :rSO2 measurements have been analyzed and validated in numerous studies, including those investigating cardiovascular and neurological surgeries and the related intensive care [4,5], and data on the usefulness of rSO2 levels for out-of-hospital cardiac arrests are available in the literature. However, data on their usefulness in witnessed in-hospital cardiac arrests are limited [6-11]. Current guidelines state that providing chest compressions with adequate rate and depth and minimizing chest compression interruptions are two of the most essential components for a successful CPR outcome [12].
On detection of spontaneous pulse by photoplethysmography in cardiopulmonary resuscitation
2020, American Journal of Emergency Medicine
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A Spanish translated version of the abstract of this article appears as Appendix in the final online version at doi:10.1016/j.resuscitation.2011.09.011.