Kei Nishiyama1, Noritoshi Ito2, Tomohiko Orita3, Kei Hayashida4, Hideki Arimoto5, Mitsuru Abe6, Takashi Unoki6, Tomoyuki Endo7, Akira Murai8, Ken Ishikura9, Noriaki Yamada10, Masahiro Mizobuchi11, Hideaki Anan12, Tomorou Watanabe13, Hideto Yasuda14, Yosuke Homma15, Kazuhiro Shiga16, Michiaki Tokura17, Yuka Tsujimura18, Tetsuo Hatanaka19, Ken Nagao20. 1. Department of Primary Care and Emergency Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan. Electronic address: keinishi@kuhp.kyoto-u.ac.jp. 2. Department of Cardiovascular Medicine, Kawasaki Saiwai Hospital, Kawasaki, Japan. 3. Department of Emergency and Critical Care Medicine, Saiseikai Yokohamashi Tobu Hospital, Yokohama, Japan. 4. Emergency and Critical Care Medicine, Keio University School of Medicine, Tokyo, Japan. 5. Department of Emergency and Critical Care Medical Center, Osaka City General Hospital, Osaka, Japan. 6. Department of Cardiology, National Hospital Organization Kyoto Medical Center, Kyoto, Japan. 7. Advanced Emergency Center, Tohoku University Hospital, Sendai, Japan. 8. Department of Emergency and Critical Care Medicine, Fukuoka University Hospital, Fukuoka, Japan. 9. Critical Care Center, Mie University Hospital, Tsu, Japan. 10. Advanced Critical Care Center, Gifu University Hospital, Gifu, Japan. 11. Department of Cardiology, Kyoto Katsura Hospital, Kyoto, Japan. 12. Department of Cardiology, Fujisawa City Hospital, Fujisawa, Japan. 13. Advanced Critical Care Center, Nara Medical University Hospital, Kashihara, Japan. 14. Emergency and Critical Care Medicine, Japanese Red Cross Musashino Hospital, Musashino, Japan. 15. Department of Emergency and Critical Care Medicine, St. Luke's International Hospital, Tokyo, Japan. 16. Emergency and Critical Care Medicine, Seirei Hamamatsu General Hospital, Hamamatsu, Japan. 17. Department of Cardiovascular Medicine, Dokkyo Medical University, Tochigi, Japan. 18. Department of Health Informatics, Kyoto University School of Public Health, Kyoto, Japan. 19. Emergency Life Saving Technique Academy, Fukuoka, Japan. 20. Department of Cardiology, Surugadai Nihon University Hospital, Tokyo, Japan.
Abstract
AIM: Our study aimed at filling the fundamental knowledge gap on the characteristics of regional brain oxygen saturation (rSO2) levels in out-of-hospital cardiac arrest (OHCA) patients with or without return of spontaneous circulation (ROSC) upon arrival at the hospital for estimating the quality of cardiopulmonary resuscitation and neurological prognostication in these patients. METHODS: We enrolled 1921 OHCA patients from the Japan - Prediction of Neurological Outcomes in Patients Post-cardiac Arrest Registry and measured their rSO2 immediately upon arrival at the hospital by near-infrared spectroscopy using two independent forehead probes (right and left). We also assessed the percentage of patients with a good neurological outcome (defined as cerebral performance categories 1 or 2) 90 days post cardiac arrest. RESULTS: After 90 days, 79 (4%) patients had good neurological outcomes and a median lower rSO2 level of 15% (15-20%). Compared to patients without ROSC upon arrival at the hospital, those with ROSC had significantly higher rSO2 levels (56% [39-65%] vs. 15% [15-17%], respectively; P<0.01), and significantly correlated right- and left-sided regional brain oxygen saturation levels (R=0.94 vs. 0.66, respectively). In both groups, the percentage of patients with a good 90-day neurological outcome increased significantly in proportion to their rSO2 levels upon arrival at the hospital (P<0.01). CONCLUSION: Our data indicate that measuring rSO2 levels might be effective for both monitoring the quality of resuscitation and neurological prognostication in patients with OHCA.
AIM: Our study aimed at filling the fundamental knowledge gap on the characteristics of regional brain oxygen saturation (rSO2) levels in out-of-hospital cardiac arrest (OHCA) patients with or without return of spontaneous circulation (ROSC) upon arrival at the hospital for estimating the quality of cardiopulmonary resuscitation and neurological prognostication in these patients. METHODS: We enrolled 1921 OHCA patients from the Japan - Prediction of Neurological Outcomes in Patients Post-cardiac Arrest Registry and measured their rSO2 immediately upon arrival at the hospital by near-infrared spectroscopy using two independent forehead probes (right and left). We also assessed the percentage of patients with a good neurological outcome (defined as cerebral performance categories 1 or 2) 90 days post cardiac arrest. RESULTS: After 90 days, 79 (4%) patients had good neurological outcomes and a median lower rSO2 level of 15% (15-20%). Compared to patients without ROSC upon arrival at the hospital, those with ROSC had significantly higher rSO2 levels (56% [39-65%] vs. 15% [15-17%], respectively; P<0.01), and significantly correlated right- and left-sided regional brain oxygen saturation levels (R=0.94 vs. 0.66, respectively). In both groups, the percentage of patients with a good 90-day neurological outcome increased significantly in proportion to their rSO2 levels upon arrival at the hospital (P<0.01). CONCLUSION: Our data indicate that measuring rSO2 levels might be effective for both monitoring the quality of resuscitation and neurological prognostication in patients with OHCA.
Authors: Awni M Al-Subu; Timothy A Hacker; Jens C Eickhoff; George Ofori-Amanfo; Marlowe W Eldridge Journal: J Clin Monit Comput Date: 2019-02-28 Impact factor: 2.502