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The prognostic value of using a jugular bulb catheter for measuring oxygen saturation in patients treated with target temperature management 33˚C after cardiac arrest: a prospective study.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences.
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(English)Manuscript (preprint) (Other academic)
Abstract [en]

Objective: To describe variations in jugular bulb oxygen saturation (SjvO2), differences in oxygen content between central venous oxygen saturation (ScvO2) and SjvO2, and oxygen extraction fraction from the brain (OEFb) during intensive care in relation to neurological outcome at 6 months post-cardiac arrest (CA) in cases where target temperature management to 33°C (TTM) was applied.

Design: Prospective observational study.

Setting: One general intensive care unit in a university hospital.

Patients: Patients over 18 years, comatose immediately after resuscitation from CA, regardless of first registered ECG rhythm or whether the CA occurred in or out of hospital.

Interventions: None.

Measurements and Main Results: One hundred and ten patients were treated with TTM 33°C post-CA and 76 received a single lumen catheter in the right jugular vein. Oxygen saturation from the arterial, jugular bulb and central venous catheter was measured in 75 patients during TTM 33°C and up to 108 hours post-CA. Neurological outcome was assessed using the Cerebral Performance Categories (CPC) and dichotomized into good and poor outcome. Thirty-seven (49%) patients survived with a good outcome (CPC 1-2) at 6 months. Patients with poor outcome showed higher levels of SjvO2 at 6,12, 96 and 108 hours, but this was only significant at 12 (p=0.032), 96 (p=0.018) and 108 hours (p=0.015).Patients with a good outcome showed higher in ScvO2 -SjvO2 values at 6 hours (p=0.001) post-CA. The OEFb was higher in patients with good outcome at 6 (p=0.048), 12 (p=0.015), 96 (p=0.008) and 108 hours (p=0.017).

Conclusions: In the present study, the main differences in the oxygen saturation measures were seen at 6, 12, 96 and 108 hours post-CA. Based on the present findings, we cannot recommend that the values obtained from the jugular bulb catheter post-CA be used to predict outcome, and thus the usefulness of SjvO2 for prognostic purposes is uncertain

Keyword [en]
cardiac arrest, hypothermia treatment, prognostication, jugular bulb saturation, intensive care, neurological outcome
National Category
Anesthesiology and Intensive Care
Research subject
Medical Science; Anaesthesiology and Intensive Care
Identifiers
URN: urn:nbn:se:uu:diva-251311OAI: oai:DiVA.org:uu-251311DiVA: diva2:805323
Available from: 2015-04-15 Created: 2015-04-15 Last updated: 2015-06-05
In thesis
1. Post Cardiac Arrest Care: Evaluation of prognostic tools, Patient outcomes and Relatives’ experiences at 6 months after the event
Open this publication in new window or tab >>Post Cardiac Arrest Care: Evaluation of prognostic tools, Patient outcomes and Relatives’ experiences at 6 months after the event
2015 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The overall aim of the present thesis was to study post-resuscitation care of cardiac arrest (CA) patients treated with target temperature management 33°C with a focus on evaluation of two prognostic tools: variations in cerebral venous saturation and acute magnetic resonance imaging (MRI) findings on the brain post-CA. An additional aim was to investigate patients’ neurological outcome and relatives’ experiences 6 months after the event. Paper I describes the cerebral oxygen saturation of blood obtained from a jugular bulb (SjvO2) catheter The results showed that patients with poor outcome tended to have higher SjvO2values,but this difference was only significant at 96 and108 hours post-CA. The main findings of Paper II were that patients with good outcome displayed a pathological pattern mainly in the frontal and parietal lobes on MRI of the brain. Patients with poor outcome had an extensive pathological pattern in several brain regions. Furthermore, very low apparent diffusion coefficient (ADC) values were associated with poor outcome regardless of brain region. Paper III investigated physical and cognitive function over time, between one month and 6 months post-CA, as well as d life satisfaction at 6 months. The results showed that impairment in physical and cognitive function is common in CA survivors but tends to decrease over time. Despite a severe illness, which has impaired the physical and cognitive functions, satisfaction with life as a whole was reported by 70% of CA survivors. In Paper IV, relatives described their experiences 6 months after a significant others CA. The analysis resulted in three themes reflecting relatives’ everyday life 6 months after the event: Difficulties managing a changed life situation, Feeling like I come second and Feeling new hope for the future. In conclusion, the results of the present thesis have increased our understanding of the two prognostic tools that were investigated; they have generated new and revealed aspects that should be taken into account during prognostication and assessing neurological outcome of this group of patients. The thesis has also shown that the healthcare needs to improve its routines for follow-ups and information provision to both patients and their relatives.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2015. 90 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1094
Keyword
cardiac arrest, hypothermia, neurological outcome, cerebral oxygenation, MRI, relatives
National Category
Anesthesiology and Intensive Care
Research subject
Medical Science
Identifiers
urn:nbn:se:uu:diva-248044 (URN)978-91-554-9225-0 (ISBN)
Public defence
2015-05-22, Grönvallsalen, ing 70, bv., Akademiska sjukhuset, Uppsala, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2015-04-28 Created: 2015-03-26 Last updated: 2015-07-07

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Wallin, EwaLarsson, Ing-MarieRubertsson, Sten

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