A "NIRS" death experience: a reduction in cortical oxygenation by time-resolved near-infrared spectroscopy preceding cardiac arrest.

Document Type

Article

Publication Date

8-1-2018

Publication Title

Journal of clinical monitoring and computing

Keywords

Cardiopulmonary Resuscitation; Cerebral Cortex; Heart Arrest; Heart Rate; Humans; Male; Middle Aged; Monitoring, Physiologic; Oxygen; Spectroscopy, Near-Infrared; Time Factors

Abstract

Near-infrared spectroscopy (NIRS) has been used effectively post-cardiac-arrest to gauge adequacy of resuscitation and predict the likelihood of achieving a return of spontaneous circulation. However, preempting hemodynamic collapse is preferable to achieving ROSC through advanced cardiac life support. Minimizing "time down" without end-organ perfusion has always been a central pillar of ACLS. In many critically ill patients there is a prolonged phase of end-organ hypoperfusion preceding loss of palpable pulses and initiation of ACLS. Due to the relative infrequency of in-hospital cardiac arrest, NIRS has not previously evaluated the period immediately prior to hemodynamic collapse. Here we report a young man who suffered a pulseless electrical activity (PEA) arrest while cortical oxygenation was monitored using time-resolved near-infrared spectroscopy. The onset of cortical deoxygenation preceded the loss of palpable pulses by 15 min, suggesting that TRS-NIRS monitoring might provide a means of preempting PEA arrest. Our experience with this patient represents a promising new direction for continuous NIRS monitoring and has the potential to not only predict clinical outcomes, but affect them to the patient's benefit as well.

Clinical Institute

Cardiovascular (Heart)

Department

Critical Care Medicine

Department

Emergency Medicine

Department

Cardiology

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