Bietet die Beurteilung der zerebralen Blutflußgeschwindigkeiten mit der transkraniellen Dopplersonographie die Möglichkeit einer frühzeitigen Prognoseabschätzung bei Patienten nach kardiopulmonaler Reanimation?

Today, progress in resuscitation techniques allows patients to survive even longer lasting cerebral hypoxia. Therefore the assessment of the neurological prognosis of these patients is of considerable importance. In the present study we performed systematic investigations of changes of blood flow velocities in the arteries of Willis in successfully resuscitated patients six times in the first 72 hours after resuscitation. Afterwards, we interpreted our findings. Additionally, vital parameters as well as ventilation parameters were registrated. Once the neuron specific enolase (NSE) was analyzed as an indicator of hypoxic brain damage. 39 patients were investigated 1.5h, 4h, 8h, 16h, 24h and 72h after resuscitation with the help of TCD. In retrospect, they were devided into the group of „survivors” (n=17) and the group of „dead patients”(n=22). 22 („dead patients”) patients died within 9 ±14 days (n=21) or remained in a vegetative state (n=1). 17 patients („survivors”) survived without moderate or severe neurological deficits. 4 hours after the cardio-pulmonary resuscitation (CPR) the systolic (80.5 ± 12.8 cm/sec) and the diastolic (30.6 ± 7.8 cm/sec) blood flow velocities of the MCA were higher in the survivors than in the dead patients (systolic 66.8 ± 19.3 cm/sec; diastolic 24.0 ± 14.1 cm/sec; p<0.05). This was also true for the blood flow velocities of the MCA 72 hours after CPR (p<0.05; survivors: systolic 101.1 ± 31.9 cm/sec, dead patients: 80.1 ± 41.2 cm/sec). 8 hours after CPR the resistance index RI (RI=(sys-dia)/sys) of the MCA and 24 hours after CPR the RI of the ACA and PCA were higher in the patients who died; e.g. RI of the MCA 8 hours after CPR: Survivors 0.62 ± 0.06, dead patients 0.68 ± 0.09. 24 hours after CPR there were significant differences in the systolic and diastolic blood flow velocities in the ACA in PCA in both groups: 24 hours after CPR the systolic (92.1 ± 35.6 cm/sec) and the diastolic (43.1 ± 24.2 cm/sec) blood flow velocities in the ACA of the survivors were significantly higher than the systolic (65.3 ± 25.1 cm/sec) and diastolic (23.1 ± 11.7 cm/sec) blood flow velocities of the patients who died. This was also true for the blood flow velocities in the PCA: 24 hours after CPR the systolic (52.2 ± 8.3 cm/sec) and the diastolic (22.4 ± 5.9 cm/sec) blood flow velocities in the PCA of the survivors are significantly higher than the systolic (45.0 ± 7.2 cm/sec) and diastolic (15.4 ± 3.9 cm/sec) blood flow velocities of the patients who died. In the first three days after CPR correlations of systolic blood flow velocities in the MCA with systolic arterial blood pressures revealed low values between +0.21 and -0.11 in the survivors early after CPR (4 to 16 hours) and high values of +0.52 to +0.81 in patients who died. This clearly pointed at the resumption of the cerebral autoregulation in the survivors; the high correlation values of those who died speak for a blood pressure passive cerebral circulation; the cerebral autoregulation of those who died was disturbed. Additionally, we calculated thresholds of systolic and diastolic blood flow velocities in different arteries 4 hours, 24 hours and 72 hours after CPR to identify patients who would survive or who would die. 24 hours after CPR at the latest all patients who would die were identified. With the help of TCD blood flow velocities in the arteries of Willis can be investigated in patients after CPR. Blood flow velocities and their changes hint at a disturbed or undisturbed cerebral autoregulation. The neurological outcome of patients after CPR can be assessed by investigations of cerebral blood flow velocities with the help of TCD.

Grantor dc:publisher

Publikationsserver der RWTH Aachen University

Year dc:date

2003

Author dc:creator

• Jacke, Christian

Contributors dc:contributor

• Klötzsch, Christof

• info:eu-repo/classification/ddc/610
• Medizin
• TCD Resuscitation

Statement dc:rights

• info:eu-repo/semantics/openAccess

Language dc:language

ger

Identifier

https://publications.rwth-aachen.de/search?p=id:%22RWTH-CONV-123164%22

OAI identifier oai:identifier

oai:publications.rwth-aachen.de:61504