Kei Nishiyama1, Noritoshi Ito2, Tomohiko Orita3, Kei Hayashida4, Hideki Arimoto5, Satoru Beppu6, Mitsuru Abe6, Takashi Unoki6, Tomoyuki Endo7, Akira Murai8, Takeshi Hatada9, Noriaki Yamada10, Masahiro Mizobuchi11, Hideo Himeno12, Kazuo Okuchi13, Hideto Yasuda14, Toshiaki Mochizuki15, Kazuhiro Shiga16, Migaku Kikuchi17, Yuka Tsujimura18, Tetsuo Hatanaka19, Ken Nagao20. 1. Department of Primary Care and Emergency Medicine, Kyoto University Graduate School of Medicine, 54 Kawara-machi, Seigoin, Sakyo-ku, Kyoto 606-8507, Japan. Electronic address: keinishi@kuhp.kyoto-u.ac.jp. 2. Department of Cardiovascular Medicine, Kawasaki Saiwai Hospital, 31-27 Oomiyachou, Saiwai-ku, Kawasaki, Kanagawa 212-0014, Japan. 3. Department of Emergency and Critical Care Medicine, Saiseikai Yokohamashi Tobu Hospital, 3-6-1 Shimosueyoshi, Tsurumi-ku, Yokohama, Kanagawa 230-0012, Japan. 4. Emergency and Critical Care Medicine, Keio University School of Medicine, Shinanomachi Shinjuku-ku, Tokyo 160-8582, Japan. 5. Department of Emergency and Critical Care Medical Centre, Osaka City General Hospital, 2-13-22 Miyakojima Hon-Dori, Miyakojima-ku, Osaka 534-0021, Japan. 6. National Hospital Organization, Kyoto Medical Centre, 1-1 Fukakusa-mukaibatakechou, Fishimi-ku, Kyoto 612-8555, Japan. 7. Advanced Emergency Centre, Tohoku University Hospital, Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8574, Japan. 8. Department of Emergency and Critical Care Medicine, Fukuoka University Hospital, 7-45-1 Nanakuma, Jyonan-ku, Fukuoka 814-0180, Japan. 9. Critical Care Centre, Mie University Hospital, 174 Edobashi 2-chome, Tsu, Mie 514-8507, Japan. 10. Advanced Critical Care Centre, Gifu University Hospital, 1-1 Yanagido, Gifu 501-1194, Japan. 11. Department of Cardiology, Kyoto Katsura Hospital, 17-Banchi, Yamada Hirao-cho, Nishikyo-ku, Kyoto 615-8256, Japan. 12. Department of Cardiology, Fujisawa City Hospital, 2-6-1, Fujisawa, Kanagawa 251-8550, Japan. 13. Advanced Critical Care Centre, Nara Medical University Hospital, 840 Shijocho, Kashihara, Nara 634-8522, Japan. 14. Emergency and Critical Care Medicine, Japanese Red Cross Musashino Hospital, 1-26-1 Sakai Minami Town, Musashino, Tokyo 180-8610, Japan. 15. Department of Emergency and Critical Care Medicine, St Luke's International Hospital, 9-1 Akashi-cho, Chuo-ku, Tokyo 104-8560, Japan. 16. Emergency and Critical Care Medicine, Seirei Hamamatsu General Hospital, 2-12-12 Sumiyoshi, Naka-ku, Hamamatsu, Shizuoka 430-8558, Japan. 17. Department of Cardiovascular Medicine, Dokkyo Medical University, 880 Kitakobayashi, Mibu-machi, Shimotsuga-gun, Tochigi 321-0293, Japan. 18. Department of Health Informatics, Kyoto University School of Public Health, Yoshida-Konoe-cho, Sakyo-ku, Kyoto 606-8501, Japan. 19. Emergency Life Saving Technique Academy, 3-8-1 Oura, Yahata-nishi-ku, Kitakyushu, Fukuoka 807-0874, Japan. 20. Department of Cardiology, Surugadai Nihon University Hospital, 1-8-13 Kanda-Surugadai, Chiyoda-ku, Tokyo 101-8309, Japan.
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.
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.
Authors: Christian Storm; Alexander Wutzler; Lars Trenkmann; Alexander Krannich; Sabrina von Rheinbarben; Fridolin Luckenbach; Jens Nee; Natalie Otto; Tim Schroeder; Christoph Leithner Journal: Scand J Trauma Resusc Emerg Med Date: 2016-04-06 Impact factor: 2.953