Napovedna vrednost nasičenosti možganov in skeletne mišice s kisikom med oživljanjem za povrnitev spontanega krvnega obtoka pri srčnem zastoju

Košir, Miha (avtor), Podbregar, Matej (mentor)

Namen dela: Srčni zastoj zunaj bolnišnice (OHCA) je pomemben vzrok obolevnosti in umrljivosti. Trenutno še ne poznamo zanesljivih napovednih dejavnikov, ki bi med kardiopulmonalnim oživljanjem napovedali uspešnost oživljanja. Z uporabo bližnje infrardeče spektroskopije (NIRS), s katero lahko merimo regionalno tkivno nasičenost s kisikom (rSO2) v skeletni mišici in možganih, bi lahko napovedovali uspešnost oživljanja. Višje vrednosti rSO2 možganov so povezane z večjo verjetnostjo za povrnitev spontanega krvnega obtoka (ROSC). Vrednosti rSO2 možganov, na podlagi katerih bi lahko napovedali izid oživljanja, še niso natančno opredeljene. Prav tako ni podrobneje raziskana povezava med rSO2 možganov in skeletne mišice pri bolnikih z netravmatskim srčnim zastojem. Namen raziskave je ugotoviti ali obstaja povezava med vrednostjo rSO2 možganov in skeletne mišice ter povrnitvijo spontanega krvnega obtoka pri bolnikih z zunajbolnišničnim srčnim zastojem. Metode: V monocentrično, prospektivno, nerandomizirano, opazovalno raziskavo, ki je potekala na območju, ki ga pokriva enota SNMP ZD Ljubljana, med septembrom 2019 in majem 2022, smo vključili 30 bolnikov z netravmatskim OHCA. Ekipa NMP je po prihodu na teren začela z dodatnimi postopki oživljanja v skladu s trenutno veljavnimi smernicami Evropskega sveta za oživljanje. Hkrati smo osebi v srčnem zastoju, čim prej po prihodu na kraj, na desno polovico čela in desno dlan v predelu mišice tenar za spremljanje rSO2 nalepili samolepilni NIRS sondi. Tkivno nasičenost s kisikom smo nepretrgoma beležili med oživljanjem in med morebitnim transportom v bolnišnico. Napravo smo odstranili ob predaji bolnika z ROSC v bolnišnici ali po prenehanju oživljanja in potrditvi smrti (brez ROSC). Podatke iz naprave smo združili s pisno dokumentacijo, ki se izpolni ob kardiopulmonalnem oživljanju na terenu. Pri vsaki meritvi smo zabeležili začetno, najvišjo in končno vrednost rSO2. Izračunali smo tudi razliko med najvišjo in začetno izmerjeno vrednostjo tkivne nasičenosti s kisikom (absolutna sprememba rSO2 – delta rSO2). Rezultati: Deset meritev smo izključili iz analize zaradi tehničnih težav ali ker niso ustrezale zahtevam protokola. Tako smo v analizo vključili 20 bolnikov (66,0 let (60,5–79,5 let), 65 % moških) z OHCA. Pri polovici vključenih bolnikov je šlo za srčni zastoj pred pričami, v 70 % primerov so očividci izvajali temeljne postopke oživljanja. Mediana dostopnega časa ekip NMP je bila 13,5 minut (11,0–19,0 minut). ROSC je bil dosežen pri petih bolnikih (25 %). Ugotovili smo korelacijo med najvišjimi vrednostmi rSO2 skeletne mišice in možganov (n = 18, rho: 0,578, p = 0,0121). Korelacije med začetno, končno rSO2 vrednostjo ter izračunano razliko (delta rSO2) skeletne mišice in možganov nismo ugotovili. Bolniki, pri katerih je bil dosežen ROSC, so imeli značilno višje začetne, najvišje in končne vrednosti rSO2 skeletne mišice v primerjavi z bolniki, kjer ROSC ni bil dosežen (začetna rSO2: 49,0 % (39,7–53,7 %) proti 15,0 % (12,0–25,2 %), p = 0,006; najvišja rSO2: 76,0 % (52,7–80,5 %) proti 34,0 % (18,0–49,5 %), p = 0,005; končna rSO2: 72,0 % (48,7–74,7 %) proti 16 % (12,0–35,0 %), p = 0,002). Bolniki z doseženim ROSC so imeli višje najvišje in končne vrednosti rSO2 možganov in izračunano razliko med začetno in najvišjo rSO2 (delta rSO2) možganov v primerjavi s skupino brez ROSC (najvišja rSO2: 77 % proti 42,0 % (30,5–53,0 %), p = 0,01; končna rSO2: 77 % proti 39,0 % (29,7–52,7 %), p = 0,01; delta rSO2: 27 % proti 10,5 % (6,0–15,0 %), p = 0,007). Zaključki: Ugotovili smo, da je med kardiopulmonalnim oživljanjem pri bolnikih z OHCA možno sočasno meriti rSO2 skeletne mišice in možganov. Ugotovili smo korelacijo med najvišjimi vrednostmi rSO2 skeletne mišice in možganov. Bolniki z ROSC so imeli v primerjavi z bolniki brez ROSC višje začetne, najvišje in končne vrednosti rSO2 skeletne mišice. Prav tako so imeli bolniki z ROSC v primerjavi z bolniki brez ROSC višje najvišje in končne vrednosti možganske rSO2 ter večji absolutni porast rSO2 v možganih. Ugotovitve kažejo na to, da bi meritve tkivne rSO2 v skeletni mišici in možganih med kardiopulmonalnim oživljanjem, lahko bile dodatna merilna metoda, ki bi odločevalcem pomagale pri napovedi prognoze oživljanja bolnikov z OHCA.

• Jezik: Slovenski jezik
• Ključne besede: srčni zastoj, infrardeča spektroskopija, regionalna tkivna nasičenost s kisikom, povrnitev spontanega krvnega obtoka, kardiopulmonalno oživljanje
• Vrsta gradiva: Doktorsko delo/naloga
• Organizacija: MF - Medicinska fakulteta
• Leto izida: 2024
• PID: 20.500.12556/RUL-164113
• Datum objave v RUL: 17.10.2024

Sekundarni jezik

• Jezik: Angleški jezik
• Naslov: Cerebral and skeletal muscle oxygenation during cardiopulmonary resuscitation as a predictor of return of spontaneous circulation

Izvleček

Background: Out-of-hospital cardiac arrest (OHCA) is a major cause of morbidity and mortality. Currently we do not know enough predictive factors to predict the success of resuscitation during cardiopulmonary resuscitation. One possibility is the use of near-infrared spectroscopy (NIRS), which can measure regional tissue oxygen saturation (rSO2) in skeletal muscle and brain tissue. Studies have shown that higher brain rSO2 levels are associated with a higher likelihood of return of spontaneous circulation (ROSC). However, they have not yet identified values that can predict the outcome of resuscitation. The association between brain and skeletal muscle rSO2 in patients with non-traumatic cardiac arrest has also not been investigated in detail. The aim of this study was to determine whether there is an association between rSO2 of brain and skeletal muscle and recovery of spontaneous circulation in patients with out of hospital cardiac arrest. Methods: 30 patients with non-traumatic OHCA were enrolled in a monocentric, prospective, non-randomised, observational study conducted in the area covered by the SNMP unit of the Ljubljana Health Centre between September 2019 and May 2022. Upon arrival, the emergency team started with advanced resuscitation procedures according to the current European Resuscitation Association guidelines. At the same time, as soon as possible after arrival on the scene, self-adhesive NIRS probes were applied to the right forehead and right hand in the region of the thenar muscle of the person in cardiac arrest. rSO2 was continuously measured during resuscitation and transport to hospital. The NIRS monitoring was stopped when the patient with ROSC was handed over to the hospital or after cessation of resuscitation and confirmation of death (no-ROSC). The data from the device were merged with the standard documentation which is filled during cardiopulmonary resuscitation in the field. For each measurement, the initial, peak and final rSO2 values were recorded. We also calculated the difference between the highest and lowest measured rSO2 value (absolute increase in rSO2, delta rSO2). Results: Ten measurements were excluded from the analysis due to technical problems or because they did not meet the requirements of the protocol. 20 patients (66.0 years (60.5–79.5 years), 65 % men) with OHCA were included in the analysis. Half of the included patients had witnessed cardiac arrest. In 70 % of witnessed cardiac arrests cases basic life support was provided. The median access time of the emergency teams was 13.5 min (11.0–19.0 min). ROSC was achieved in five patients (25 %). There was a correlation between the highest skeletal muscle and brain rSO2 values (n = 18, rho: 0.578, p = 0.0121). There was no correlation between the baseline, final rSO2 and delta rSO2 between skeletal and brain rSO2. Patients with ROSC had statistically significantly higher initial, peak and final skeletal muscle rSO2 values compared to patients with no-ROSC (initial rSO2: 49.0 % (39.7–53.7 %) vs. 15.0 % (12.0–25.2 %), p = 0.006; peak rSO2: 76.0 % (52.7–80.5 %) vs. 34.0 % (18.0–49.5 %), p = 0.005; final rSO2: 72.0 % (48.7–74.7 %) vs. 16 % (12.0–35.0 %), p = 0.002). Brain peak rSO2, final rSO2 and delta rSO2 values in patients with ROSC were statistically significantly higher, compared to the no-ROSC group, in (peak rSO2: 77 % vs. 42.0 % (30.5–53.0 %), p = 0.01; final rSO2: 77 % vs. 39.0 % (29.7–52.7 %), p = 0.01; delta rSO2: 27 % vs. 10.5 % (6.0–15.0 %), p = 0.007). Conclusion: We have demonstrated that it is possible to measure rSO2 in skeletal muscle and brain simultaneously during cardiopulmonary resuscitation in patients with OHCA. There was a correlation between the peak rSO2 values of skeletal muscle and brain. Compared with patients no-ROSC, patients with ROSC had higher initial, peak and final skeletal muscle rSO2 values; higher peak and final brain rSO2 values and a greater absolute increase in brain rSO2. The findings suggest that rSO2 measurements of skeletal muscle and the brain, during cardiopulmonary resuscitation, could be an additional measurement method to help decision makers predict resuscitation prognosis in patients with OHCA.

• Ključne besede: cardiac arrest, near-infrared spectroscopy, regional tissue oxygen saturation, return of spontaneous circulation, cardiopulmonary resuscitation