Usefulness of cerebral rSO2 monitoring during CPR to predict the probability of return of spontaneous circulation

Abstract

Background: Cerebral oximetry (rSO 2) may be useful in assessing the probability of return of spontaneous circulation (ROSC). However, the potential of assessing the trend in the rSO 2 value has not been discussed when determining the probability of ROSC. Methods: This was a retrospective study of out-of-hospital cardiac arrest (OHCA) patients with continuous rSO 2 values recorded during cardiopulmonary arrest. We used logistic regression analysis at each time point to investigate the best subsets of rSO 2-related variables for ROSC, which included rSO 2 (baseline), the baseline value of rSO 2 ; amount of maximum rise, the maximum difference of rSO 2 from rSO 2 (baseline) over t minutes; DrSO 2 (t):(amount of maximum rise)/rSO 2 (baseline) over t minutes after hospital arrival. Results: Among the 90 included patients, 35 achieved ROSC. Area under the curve (AUC) analysis revealed that DrSO 2 over a 16-min measurement period was significantly higher than DrSO 2 measured over 4-, 8-, 12-, and 20-min periods. During this 16-min period, the subset showing the best AUC value was interaction of the amount of maximum rise and rSO 2 (baseline) rather than the amount of maximum rise or DrSO 2 alone (AUC = 0.91). Conclusions: The combination of rSO 2 (baseline) with the amount of maximum rise in rSO 2 value over time might be a new index for the prediction of ROSC that could be useful in guiding cardiopulmonary resuscitation. Further studies are needed to validate these findings.

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

“…Furthermore, some authors have suggested that dynamic assessments of rSO 2 obtained throughout resuscitation are more appropriate than static assessments for evaluating outcomes in patients with CA ( 22 ). In a single-center retrospective study, Takegawa et al evaluated the association between the probability of ROSC and the degree of rSO 2 increase during CPR among 90 patients with OHCA, 35 (38.9%) of whom achieved ROSC ( 65 ). Receiver operating characteristic curve (ROC) analysis revealed that the amount of maximum rise in rSO 2 value (i.e., the difference between maximum and baseline values) over a 16-min measurement period yielded an AUC of 0.75 for differentiating between the ROSC and non-ROSC groups.…”

“…Receiver operating characteristic curve (ROC) analysis revealed that the amount of maximum rise in rSO 2 value (i.e., the difference between maximum and baseline values) over a 16-min measurement period yielded an AUC of 0.75 for differentiating between the ROSC and non-ROSC groups. In addition, the best AUC value was achieved by the combination of the amount of maximum rise and baseline rSO 2 , rather than by the amount of maximum rise alone (AUC = 0.91) ( 65 ). The authors suggested that discontinuation of CPR may be indicated in patients with low initial values who do not exhibit an appropriate increase in rSO 2 , resulting in a low mean value.…”

Pediatric Life Support: 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations

“…[92][93][94] A trend of rising rSco 2 (between 7% and 15% from baseline measurement) may be a more reliable predictive factor for ROSC. 90,95,96 The ScopRev also identified 2 observational studies of NIRS in children during CPR. One found that cerebral physiological changes were associated with changed NIRS measurements during cardiac arrest, increased intracranial pressure reduction, arrest resolution, and after ROSC.…”

Pediatric Life Support

“… 92 , 93 , 94 A trend of rising rS O 2 (between 7% and 15% from baseline measurement) may be a more reliable predictive factor for ROSC. 90 , 95 , 96 …”