Cerebral Oximetry After Cardiac Arrest (COACA)

心脏骤停后的临床结果非常不利，死亡率超过90%，50%以上的幸存者有永久性脑损伤。心肺复苏（CPR）的关键终点是通过建立和维持脑灌注和氧合来预防死亡和发病；然而，目前还没有简单可靠的方法来评估心脏骤停患者的脑组织灌注是否充足。心脏骤停后脑氧饱和度（COACA） II期研究的目标是开发和验证无创脑组织氧饱和度（SbtO2）作为心脏骤停复苏期间和之后脑灌注和氧合的简单有效的测量方法。我们假设SbtO2监测可能有一天会被常规用于(1)评估胸外按压的充分性，(2)避免过度换气或寒战引起的脑组织缺氧，(3)作为目标导向的血流动力学（血压）支持的终点，(4)评估神经系统恢复的潜力。在哥伦比亚大学医学中心收治的心脏骤停患者，将使用近红外光谱（EQUANOX rSO2技术脑血氧仪，通过胶粘剂引线应用于双侧太阳穴）在心肺复苏术期间和48小时内（或直到死亡）测量脑氧合（SbtO2）。除了急性期的其他参数（血压、动脉血氧饱和度、末潮CO2和心排血量）外，入院后90天还将测量神经系统预后。研究的成功完成将有望确立在心肺复苏术期间和之后监测SbtO2是可行的，并且是神经恢复的有效预测指标。如果得到证实，预计SbtO2监测仪可能有一天会被常规纳入便携式心脏除颤器。最佳SbtO2的阈值将被确定，未来的多中心研究将被设计来确定目标导向的复苏后血流动力学支持是否能在ICU中维持最佳SbtO2值，从而改善神经系统预后。

Clinical outcome after sudden cardiac arrest is very unfavorable with mortality rates of more than 90% and permanent brain damage in more than 50% of survivors The critical endpoint of cardio pulmonary resuscitation (CPR) is to prevent death and morbidity by establishing and maintaining brain perfusion and oxygenation; however, there is currently no simple and reliable way to evaluate the adequacy of brain tissue perfusion in cardiac arrest patients.The goal of the phase II study Cerebral Oximetry after Cardiac Arrest (COACA) is to develop and validate non-invasive brain tissue oxygen saturation (SbtO2) as a simple and effective measure of brain perfusion and oxygenation during and after resuscitation from cardiac arrest. We hypothesize that SbtO2 monitoring may one day be routinely used to (1) evaluate the adequacy of chest compressions, (2) avoid brain tissue hypoxia induced by excessive hyperventilation or shivering, (3) serve as an endpoint for goal-directed hemodynamic (blood pressure) support, and (4) evaluate the potential for neurological recovery. In cardiac arrest patients admitted to Columbia University Medical Center measurement of cerebral oxygenation (SbtO2) will be performed using near-infrared-spectroscopy (EQUANOX rSO2 technology brain oximeter, applied to via adhesive leads to the temples bilaterally) during and 48 hours after CPR (or until death). Apart from other parameters in the acute phase (blood pressure, arterial oxygen saturation, end tidal CO2 and cardiac output), neurological outcome will be measured until 90 days after hospital admission.Successful completion of the research will hopefully establish that SbtO2 monitoring is feasible during and after CPR and is a valid predictor of neurological recovery. If confirmed, it is anticipated that SbtO2 monitors may one day be routinely incorporated into portable cardiac defibrillators. Thresholds for optimal SbtO2 will be established, and future multicenter studies will be designed to determine whether goal-directed post-resuscitation hemodynamic support targeted at maintaining optimal SbtO2 values in the ICU can improve neurological outcome.