Elsevier

Resuscitation

Volume 96, November 2015, Pages 135-141
Resuscitation

Clinical paper
Regional cerebral oxygen saturation monitoring for predicting interventional outcomes in patients following out-of-hospital cardiac arrest of presumed cardiac cause: A prospective, observational, multicentre study

https://doi.org/10.1016/j.resuscitation.2015.07.049Get rights and content
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Abstract

Aim

This study investigated the value of regional cerebral oxygen saturation (rSO2) monitoring upon arrival at the hospital for predicting post-cardiac arrest intervention outcomes.

Methods

We enrolled 1195 patients with out-of-hospital cardiac arrest of presumed cardiac cause from the Japan-Prediction of Neurological Outcomes in Patients Post-cardiac Arrest Registry. The primary endpoint was a good neurologic outcome (cerebral performance categories 1 or 2 [CPC1/2]) 90 days post-event.

Results

A total of 68 patients (6%) had good neurologic outcomes. We found a mean rSO2 of 21% ± 13%. A receiver operating characteristic curve analysis indicated an optimal rSO2 cut-off of ≥40% for good neurologic outcomes (area under the curve 0.92, sensitivity 0.81, specificity 0.96). Good neurologic outcomes were observed in 53% (55/103) and 1% (13/1092) of patients with high (≥40%) and low (<40%) rSO2, respectively. Even without return of spontaneous circulation (ROSC) upon arrival at the hospital, 30% (9/30) of patients with high rSO2 had good neurologic outcomes. Furthermore, 16 patients demonstrating ROSC upon arrival at the hospital and low rSO2 had poor neurologic outcomes. Multivariate analyses indicated that high rSO2 was independently associated with good neurologic outcomes (odds ratio = 14.07, P < 0.001). Patients with high rSO2 showed favourable neurologic prognoses if they had undergone therapeutic hypothermia or coronary angiography (CPC1/2, 69% [54/78]). However, 24% (25/103) of those with high rSO2 did not undergo these procedures and exhibited unfavourable neurologic prognoses (CPC1/2, 4% [1/25]).

Conclusion

rSO2 is a good indicator of 90-day neurologic outcomes for post-cardiac arrest intervention patients.

Abbreviations

AUC
area under the curve
CAG
coronary angiography
CI
confidence interval
CPC
Glasgow–Pittsburgh cerebral performance category
CPR
cardiopulmonary resuscitation
GCS
Glasgow Coma Scale
J-POP
Japan-Prediction of Neurological Outcomes in Patients Post-Cardiac Arrest
OHCA
out-of-hospital cardiac arrest
PCAI
post-cardiac arrest intervention
PCI
percutaneous coronary intervention
ROC
receiver operating characteristic
ROSC
return of spontaneous circulation
rSO2
regional cerebral oxygen saturation
TH
therapeutic hypothermia

Keywords

Cardiopulmonary resuscitation
Cerebrovascular circulation
Cardiac arrest
Oxygen
Prognoses

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A Spanish translated version of the abstract of this article appears as Appendix in the final online version at http://dx.doi.org/10.1016/j.resuscitation.2015.07.049.