The clinical implications of continuous central venous oxygen saturation during human CPR.
OBJECTIVE
The purpose of this study was to observe, measure, and describe the changes in central venous oxygen saturation during CPR and immediately after return of spontaneous circulation. It also was to examine the clinical utility of continuous central venous oxygen saturation monitoring as a indicator of return of spontaneous circulation during CPR in human beings.


METHODS
Eight-month, prospective, non-outcome, observational, nonrandomized case series in the ED of a large urban hospital. TYPES OF PATIENTS: Adult normothermic, nontraumatic, out-of-hospital cardiopulmonary arrests.


METHODS
All patients were managed according to advanced cardiac life support guidelines. A proximal aortic and double-lumen central venous catheter was placed. Central venous oxygen saturation was measured continuously spectrophotometrically with a fiberoptic catheter in the central venous location.


METHODS
Aortic blood pressure and central venous oxygen saturation were simultaneously measured throughout each resuscitation. Return of spontaneous circulation was defined as a systolic blood pressure of more than 60 mm Hg for more than five minutes.


RESULTS
One hundred patients who experienced 68 episodes of cardiac arrest were studied. Patients with return of spontaneous circulation had a higher initial and statistically higher mean and maximal central venous oxygen saturation than those without return of spontaneous circulation (P = .23, .0001, and .0001, respectively; P less than .05 is significant). No patient attained return of spontaneous circulation without reaching a central venous oxygen saturation of at least 30%. Only one of 68 episodes of return of spontaneous circulation was attained without reaching a central venous oxygen saturation of at least 40%. A central venous oxygen saturation of greater than 72% was 100% predictive of return of spontaneous circulation.


CONCLUSIONS
Continuous central venous oxygen saturation monitoring can serve as a reliable indicator of return of spontaneous circulation during CPR in human beings.
Rivers
E P
EP
Department of Emergency Medicine, Henry Ford Health Systems, Detroit, Michigan.
Martin
G B
GB
Smithline
H
H
Rady
M Y
MY
Schultz
C H
CH
Goetting
M G
MG
Appleton
T J
TJ
Nowak
R M
RM
D001775:Blood Circulation / Q000502:physiology*; D001776:Blood Circulation Time; D016887:Cardiopulmonary Resuscitation; D006323:Heart Arrest / Q000503:physiopathology* / Q000628:therapy; D006801:Humans; D008875:Middle Aged; D010101:Oxygen Consumption / Q000502:physiology*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D013997:Time Factors