Cerebral oximetry and cerebral blood flow monitoring in 2 pediatric survivors with out-of-hospital cardiac arrest

In pediatric out-of-hospital cardiac arrest (POHCA), cardiovascular monitoring tools have improved resuscitative endeavors and cardiovascular outcomes but with still poor neurologic outcomes. Regarding cardiac arrest in patients with congenital heart disease during surgery, the application of cerebr...

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Bibliographic Details
Published in:The American journal of emergency medicine 2014-04, Vol.32 (4), p.394.e5-394.e10
Main Authors: Abramo, Thomas, MD, Aggarwal, Nitin, MD, Kane, Ian, MD, Crossman, Kristen, MD, Meredith, Mark, MD
Format: Article
Language:English
Subjects:
Adolescent
Cardiac arrest
Cardiopulmonary Resuscitation
Cerebrovascular Circulation
CPR
Emergency
Emergency medical care
Female
Heart attacks
Hospitals
Humans
Ischemia
Male
Monitoring systems
Mortality
Out-of-Hospital Cardiac Arrest - blood
Out-of-Hospital Cardiac Arrest - therapy
Oximetry - methods
Patients
Pediatrics
Regional Blood Flow
Spectrum analysis
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Summary:In pediatric out-of-hospital cardiac arrest (POHCA), cardiovascular monitoring tools have improved resuscitative endeavors and cardiovascular outcomes but with still poor neurologic outcomes. Regarding cardiac arrest in patients with congenital heart disease during surgery, the application of cerebral oximetry with blood volume index (BVI) during the resuscitation has shown significant results and prognostic significance. We present 2 POHCA patients who had cerebral oximetry with BVI monitoring during their arrest and postarrest phase in the emergency department and its potential prognostic aspect.Basic procedures include left and right cerebral oximetry with BVI monitoring at every 5-second interval during cardiac arrest, resuscitation, and postarrest in 2 POHCA patients in the pediatric emergency department.Regional cerebral tissue oxygen saturation (rSo2) with BVI readings in these 2 POHCA survivors demonstrated interesting cerebral physiology, blood flow, and potential prognostic outcome. In 1 patient, the reference range of cerebral rSo2 with positive blood flow during arrest and postarrest phases consistently occurred. This neurologic monitoring had its significance when the resuscitation effectiveness was used and end-tidal CO2 changes were lost. The other patient's cerebral rSo2 with simultaneous BVI readings and trending showed the effectiveness of the emergency medical services (EMS) resuscitation.Cerebral oximetry with cerebral blood flow index monitoring in these POHCA survivors demonstrates compelling periarrest and postarrest cerebral physiology information and prognostication. Cerebral oximetry with cerebral BVI monitoring during these arrest phases has potential as a neurologic monitor for the resuscitative intervention's effectiveness and its possible neurologic prognostic application in the pediatric OCHA patients.
ISSN:0735-6757
1532-8171
DOI:10.1016/j.ajem.2013.10.039