CARDIOVASCULAR ENGINEERING Journal for Extracorporeal Circulation, Assist Devices,Transplantation and Artificial Organs
	Volume 2, 1997, No 2

Brain-Tissue PO2 during Cardiac Arrest and Cerebral Herniation in Patients with Severe Head Injuries

R. Härtl, T. F. Bardt, K. L. Kiening, A. S. Sarrafzadeh, G.-H. Schneider, A. W. Unterberg

Abstract:
Background: Over the past years ICU monitoring of brain tissue PO2 and oxygenation in comatose patients with traumatic brain injury (TBI) has attracted increasing interest. The purpose of this article is to present our recent experience with direct monitoring of cerebral white matter partial pressure of 02 (PtiO2) using Clark-type polarographic PO2 electrodes in two patients experiencing cardiac arrest and cerebral herniation. Methods: From 32 severe TBI patients (Glasgow Coma Scale <8) monitored so far in our icu two patients experiencing cardiac arrest (patient b.k.) and cerebral herniation (patient m.s.) are presented. for ptio2 monitoring a polarographic microcatheter was inserted into the frontal cerebral white matter and intracranial pressure (icp) was monitored by an intraparenchymal catheter. ptio2, mean arterial blood pressure, cerebral perfusion pressure, end-tidal co2 and arterial oxygen saturation (pulse oximetry) were continuously recorded and simultaneously stored and analyzed by a multimodal computer system. patients were treated according to a standardized protocol including surgical evacuation of space occupying lesions and a defined cascade of therapeutical interventions for intracranial hypertension. the data presented here are from the recordings taken over 30 min during the acute insults. results: ventricular fibrillation in patient b.k. resulted in a complete breakdown of blood pressure and a drop of ptio2 from 25 mmhg to < 5 mmhg within 1 min. defibrillation and infusion of catecholamines and anti-arrhythmic drugs re-established blood pressure and normalized ptio2 within minutes. the patient survived with moderate disability at 3 months. patient m.s. suffered a traumatic acute subdural hematoma that was surgically evacuated. subsequently, intracranial hypertension developed that could only be controlled with mannitol, hyperventilation and barbiturates. on post-trauma day 9 icp suddenly increased to > 100 mmhg and ptio2 fell to < 5 mmhg within 2 min and the patient expired shortly thereafter. conclusion: our data illustrate that monitoring of ptio2 is a feasible and easy to use technique that provides pathophysiologically reliable information about the oxygen supply to the brain in situations of acute intracranial complications and cerebrovascular dysfunction.

Keywords:
Brain tissue pO2, head injury, cerebral ischemia, cardiac arrest, cerebral herniation, multimodal cerebral monitoring

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Reference:
(CVE. 1997; 2 (2): 120-126)

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