Key result
Cerebral NIRS values paradoxically remained within the normal range (above 68%) despite a prolonged perioperative cardiac arrest and the absence of systemic blood flow.
Why the study?
Patients undergoing cardiac surgery are at risk of adverse perioperative neurological complications, and cerebral oximetry monitoring with NIRS is increasingly used to detect intraoperative hypoxia or ischemia.
Case Report (n=1)
No
NIRS monitoring may show paradoxically normal cerebral tissue oxygenation values despite prolonged perioperative cardiac arrest and absence of systemic blood flow, highlighting the need for careful interpretation of these values in complex clinical situations.
Caution interpreting normal NIRS during arrest; leaves open its reliability in no-flow states.
BACKGROUND Patients undergoing cardiac surgery are at risk of adverse perioperative neurological complications. Cerebral oximetry monitoring is increasingly used in these patients to detect intraoperative cerebral hypoxia or ischemic events. Near-infrared spectroscopy (NIRS) uses the near-infrared region of the electromagnetic spectrum for oximetry imaging. A case is reported of the persistence of normal tissue oxygenation monitored by NIRS values despite a prolonged perioperative cardiac arrest. CASE REPORT A 65-year-old man was admitted to the Emergency Department with dysarthria, left facial ptosis, left hemiplegia, and arterial hypotension of 75/50 mmHg. Computed tomography (CT) angiography showed a Stanford type A aortic dissection extending to the right common carotid artery. Shortly after arrival in the operating room, his hemodynamic condition rapidly deteriorated resulting in cardiac arrest. Despite the rapid onset of extracorporeal circulation, adequate systemic blood flow could not be restored. Cerebral NIRS values remained within the normal range (70-80%) from the start of emergency resuscitation, during a prolonged period of extremely low global blood perfusion values, and until all resuscitation ceased. CONCLUSIONS Cerebral oximetry values reflect a balance between cerebral oxygen delivery and consumption. This case demonstrated the persistence of normal tissue oxygenation monitored by NIRS values despite a prolonged perioperative cardiac arrest.
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Maillard et al. (2019) conducted a case report in Aortic dissection and perioperative cardiac arrest (n=1). Near-infrared spectroscopy (NIRS) was evaluated on Cerebral regional tissue oxygen saturation (rSO2). Cerebral NIRS values paradoxically remained within the normal range (above 68%) despite a prolonged perioperative cardiac arrest and the absence of systemic blood flow.
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