Association between regional cerebral oxygen saturation and outcome of patients with out-of-hospital cardiac arrest: An observational study

Takeshi Kawaguchi; Jumpei Tsukuda; Rika Onoe; Kenichiro Morisawa; Toru Yoshida; Koichi Hayashi; Shigeki Fujitani

doi:10.1016/j.resplu.2022.100343

Association between regional cerebral oxygen saturation and outcome of patients with out-of-hospital cardiac arrest: An observational study

Resusc Plus. 2023 Jan 12:13:100343. doi: 10.1016/j.resplu.2022.100343. eCollection 2023 Mar.

Authors

Takeshi Kawaguchi¹, Jumpei Tsukuda¹, Rika Onoe¹, Kenichiro Morisawa¹, Toru Yoshida¹, Koichi Hayashi², Shigeki Fujitani¹

Affiliations

¹ Department of Emergency and Critical Care Medicine, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa 216-8511, Japan.
² Department of Emergency and Critical Care Medicine, St. Marianna University, Yokohama City Seibu Hospital, 1197-1 Yasashi-cho, Asahi-ku, Yokohama, Kanagawa 241-0811, Japan.

Abstract

Aim: This study aimed to evaluate the association between cerebral oxygen saturation (StO2) and return of spontaneous circulation (ROSC) in patients with out-of-hospital cardiac arrest (OHCA).

Methods: We retrospectively evaluated the data of patients with OHCA to determine the association between ROSC and various StO2 parameters (initial_StO2, final_StO2, mean_StO2, and Δ_StO2 [=final_StO2-initial_StO2]). Time-domain near-infrared spectroscopy was used to determine absolute StO2 values.

Results: Of the 108 patients with OHCA, 23 achieved ROSC. Although initial_StO2 values did not differ between the groups, final_StO2, mean_StO2, and Δ_StO2 were higher in the ROSC group than in the non-ROSC group. The cut-off values for initial_StO2, mean_StO2, and Δ_StO2 as predictors of ROSC were 35%, 30%, and 5%, respectively. The odds ratio for ROSC had markedly increased in the Δ_StO2 ≥ 5% subgroup (19.70 [6.06-64.11], p < 0.001). When the change in StO2 (=d_StO2) at 8 min from the initiation of StO2 measurement was assessed, the d_StO2 ≥ 5% subgroup had a higher odds ratio for ROSC than the d_StO2 < 5% subgroup (5.8 [1.78-18.85], p = 0.002), and this tendency was maintained until 20 min. In the evaluation using a two-by-two contingency table with initial_StO2 and Δ_StO2 as two parameters, 61.9% of the patients fell under the categories of initial_StO2 < 35% and Δ_StO2 < 5% and had the lowest rate of ROSC achievement (4.6%). In the Δ_StO2 ≥ 5% subgroup, approximately-two-thirds of the patients achieved ROSC irrespective of the initial_StO2 (initial_StO2 ≥ 35%, 66.7%; initial_StO2 < 35%, 60.0%).

Conclusions: Initial_StO2 and Δ_StO2 were associated with the achievement of ROSC.

Keywords: CPR, cardiopulmonary resuscitation; Cardiopulmonary resuscitation; Cerebral oxygen saturation; Discriminant analysis; NIRS, near-infrared spectroscopy; Near-infrared spectroscopy; OHCA, out-of-hospital cardiac arrest; Return of spontaneous circulation; StO2, regional cerebral oxygen saturation; TOI, tissue oxygenation index.