Prognosis value of dynamic variation of tissue oxygen saturation during severe cardiogenic shock

Introduction

To evaluate the prognosis value of dynamic thenar O₂ saturation (StO₂) response using a vascular occlusion test (VOT) during cardiogenic shock.

Methods

A retrospective clinical observational analysis was performed on adult patients treated for severe cardiogenic shock in a surgical ICU. The non-invasive InSpectra near-infrared spectrometer was used to assess the effect of VOT on thenar eminence StO₂. The VOT manoeuvre was repeated within the first 24 hours of admission. StO₂ VOT-induced changes were compared between surviving and nonsurviving patients between the first 8 hours and the next 16 hours.

Results

Ten patients suffering from cardiogenic shock (age 59.8 ± 13.8 years; APACHE score 21.3 ± 5.9) were treated with inotropes (n = 7) and/or circulatory mechanical assistance (four IABP, three ELS, one LVAD) and vasopressors (n = 9). Mortality in the ICU was 50%. Hemodynamic and metabolic parameters were not different between survivors and nonsurvivors (Table 1). The post-VOT StO₂ recovery slope tended to be faster within the first 8 hours in survivors than in nonsurvivors (2.8 ± 1.1 vs. 1.7 ± 0.4%/s, P = 0.09) and improved significantly in the H8 to H24 period (4.5 ± 1.2 vs. 2 ± 1.1%/s, P = 0.007). The post-VOT StO₂ recovery slope increased significantly within the first 24 hours in all survivors (Figure 1).

Table 1.

Hemodynamic parameters within the first 8 hours in the ICU

	Survivors	Nonsurvivors	P value
MAP	85	70	0.08
CI	2.4	2.3	1
ScvO2	65	57	0.45
Lactate	4.4	8	0.47
StO2	77	81	0.35

Figure 1.

StO₂ recovery slope (mean).

Conclusions

Our results suggest that, in patients treated for cardiogenic shock, rapid improvement in the post-VOT StO₂ recovery slope is associated with a better prognosis.