Dynamic Changes of the Hemoglobin Index During Resuscitation in Patients with Out-of-hospital Cardiopulmonary Arrest Due to Freshwater Drowning: A Retrospective Observational Study

Overview

Journal Resusc Plus

Date 2021 Nov 24

PMID 34816141

Authors

Tomoya Hirose

Tomohiko Sakai

Ryosuke Takegawa

Mitsuo Ohnishi

Jotaro Tachino

Arisa Muratsu

Shunichiro Nakao

Tadahiko Shiozaki

Affiliations

Soon will be listed here.

Abstract

Background: The hemoglobin index (HbI) represents the amount of hemoglobin, which reflects the regional tissue blood volume. The HbI is calculated by a regional oxygen saturation monitor. In freshwater drowning, inhaled water is immediately absorbed into the blood causing hemodilution. We hypothesized that this blood dilution could be observed in real time using HbI values in patients with out-of-hospital cardiac arrest (OHCA) due to freshwater drowning.

Methods: In this single-center retrospective, observational study, we examined the HbI in patients with OHCA due to freshwater drowning from April 2015 to May 2020. Patients with OHCA due to hanging were selected as a control group.

Results: Thirty-two patients in the freshwater drowning group and 21 in the control group were eligible for inclusion. In the freshwater drowning group, the HbI values in the return of spontaneous circulation (ROSC) group were significantly decreased in comparison to the non-ROSC group (-0.28 [IQR -0.55, -0.12] vs. -0.04 [IQR -0.16, 0.025]; = 0.024). In the control group, the change of HbI during resuscitation in the ROSC and non-ROSC groups was not significantly different (0.11 [IQR -0.3525, 0.4225] vs. -0.02 [IQR -0.14, 0.605]; = 0.8228). In each patient with ROSC in the freshwater drowning group, the HbI value after ROSC was significantly decreased in comparison to before ROSC (1.2±0.5 vs. 0.9±0.5]; = 0.0156). In contrast, this difference was not observed in patients with an ROSC in the control group (3.7±1.3 vs. 3.8±1.4]; = 0.7940).

Conclusion: Blood dilution induced by freshwater drowning might be detected in real time using the HbI. To prove the validity of this research's result, further prospective large study is needed.

References

Takegawa R, Shiozaki T, Ogawa Y, Hirose T, Mori N, Ohnishi M . Usefulness of cerebral rSO monitoring during CPR to predict the probability of return of spontaneous circulation. Resuscitation. 2019; 139:201-207. DOI: 10.1016/j.resuscitation.2019.04.015. View

Duggal C, Weil M, Gazmuri R, Tang W, Sun S, OConnell F . Regional blood flow during closed-chest cardiac resuscitation in rats. J Appl Physiol (1985). 1993; 74(1):147-52. DOI: 10.1152/jappl.1993.74.1.147. View

Takegawa R, Hayashida K, Rolston D, Li T, Miyara S, Ohnishi M . Near-Infrared Spectroscopy Assessments of Regional Cerebral Oxygen Saturation for the Prediction of Clinical Outcomes in Patients With Cardiac Arrest: A Review of Clinical Impact, Evolution, and Future Directions. Front Med (Lausanne). 2020; 7:587930. PMC: 7673454. DOI: 10.3389/fmed.2020.587930. View

Ehara N, Hirose T, Shiozaki T, Wakai A, Nishimura T, Mori N . The relationship between cerebral regional oxygen saturation during extracorporeal cardiopulmonary resuscitation and the neurological outcome in a retrospective analysis of 16 cases. J Intensive Care. 2017; 5:20. PMC: 5324259. DOI: 10.1186/s40560-017-0216-1. View

Ogawa Y, Shiozaki T, Hirose T, Ohnishi M, Nakamori Y, Ogura H . Load-distributing-band cardiopulmonary resuscitation for out-of-hospital cardiac arrest increases regional cerebral oxygenation: a single-center prospective pilot study. Scand J Trauma Resusc Emerg Med. 2015; 23:99. PMC: 4644276. DOI: 10.1186/s13049-015-0182-3. View

Myers D, McGraw M, George M, Mulier K, Beilman G . Tissue hemoglobin index: a non-invasive optical measure of total tissue hemoglobin. Crit Care. 2009; 13 Suppl 5:S2. PMC: 2786104. DOI: 10.1186/cc8000. View

Zatopkova L, Hejna P, Janik M . Hemolytic staining of the endocardium of the left heart chambers: a new sign for autopsy diagnosis of freshwater drowning. Forensic Sci Med Pathol. 2014; 11(1):65-8. DOI: 10.1007/s12024-014-9620-1. View

Bierens J, Lunetta P, Tipton M, Warner D . Physiology Of Drowning: A Review. Physiology (Bethesda). 2016; 31(2):147-66. DOI: 10.1152/physiol.00002.2015. View

Mori N, Hirose T, Shiozaki T, Ogawa Y, Takegawa R, Tachino J . Effectiveness of the hemoglobin index for screening of subarachnoid hemorrhage in out-of-hospital cardiopulmonary arrest patients: a retrospective observational study. Acute Med Surg. 2020; 7(1):e450. PMC: 6971453. DOI: 10.1002/ams2.450. View

10.

Voorhees 3rd W, Ralston S, Kougias C, Schmitz P . Fluid loading with whole blood or Ringer's lactate solution during CPR in dogs. Resuscitation. 1987; 15(2):113-23. DOI: 10.1016/0300-9572(87)90022-0. View

11.

Hirose T, Shiozaki T, Nomura J, Hamada Y, Sato K, Katsura K . Pre-hospital portable monitoring of cerebral regional oxygen saturation (rSO2) in seven patients with out-of-hospital cardiac arrest. BMC Res Notes. 2016; 9(1):428. PMC: 5007866. DOI: 10.1186/s13104-016-2239-4. View

12.

Rebet O, Fischer M, Zamparini G, Gerard J, Fellahi J, Hanouz J . Near-Infrared Spectroscopy Hemoglobin Index Measurement During Fluid Challenge: A Prospective Study in Cardiac Surgery Patients. J Cardiothorac Vasc Anesth. 2015; 29(4):924-9. DOI: 10.1053/j.jvca.2015.01.013. View

13.

Sakai T, Hirose T, Shiozaki T, Takagawa R, Ohnishi M, Hayashida S . Pre-hospital portable monitoring of cerebral regional oxygen saturation (rSO) by ambulance personnel during cardiopulmonary resuscitation: A prospective observational analysis of 87 cases in Osaka city, Japan. Resusc Plus. 2021; 6:100093. PMC: 8244519. DOI: 10.1016/j.resplu.2021.100093. View

14.

Byard R, Cains G, Simpson E, Eitzen D, Tsokos M . Drowning, haemodilution, haemolysis and staining of the intima of the aortic root-- preliminary observations. J Clin Forensic Med. 2006; 13(3):121-4. DOI: 10.1016/j.jcfm.2006.01.003. View

15.

Ditchey R, Lindenfeld J . Potential adverse effects of volume loading on perfusion of vital organs during closed-chest resuscitation. Circulation. 1984; 69(1):181-9. DOI: 10.1161/01.cir.69.1.181. View