A feasibility study evaluating the role of cerebral oximetry in predicting return of spontaneous circulation in cardiac arrest.
To date there has been no reliable noninvasive real time monitoring available to determine cerebral perfusion during cardiac arrest.


OBJECTIVE
To investigate the feasibility of using a commercially available cerebral oximeter during in-hospital cardiac arrest, and determine whether this parameter predicts return of spontaneous circulation (ROSC).


METHODS
Cerebral oximetry was incorporated in cardiac arrest management in 19 in-hospital cardiac arrest cases, five of whom had ROSC. The primary outcome measure was the relationship between rSO(2) and ROSC.


RESULTS
The use of cerebral oximetry was found to be feasible during in hospital cardiac arrest and did not interfere with management. Patients with ROSC had a significantly higher overall mean ± SE rSO(2) (35 ± 5 vs. 18 ± 0.4, p<0.001). The difference in mean rSO(2) between survivors and non-survivors was most pronounced in the final 5 min of cardiac arrest (48 ± 1 vs. 15 ± 0.2, p<0.0001) and appeared to herald imminent ROSC. Although spending a significantly higher portion of time with an rSO(2)>40% was found in survivors (p<0.0001), patients with ROSC had an rSO(2) above 30% for >50% of the duration of cardiac arrest, whereas non-survivors had an rSO(2) that was below 30%>50% of their cardiac arrest. Patients with ROSC also had a significantly higher change in rSO(2) from baseline compared to non-survivors (310% ± 60% vs. 150% ± 27%, p<0.05).


CONCLUSIONS
Cerebral oximetry may have a role in predicting ROSC and the optimization of cerebral perfusion during cardiac arrest.
Resuscitation Research Group, Department of Medicine, State University of New York at Stony Brook, Stony Brook, NY 11794, United States. Sam.Parnia@stonybrookmedicine.edu
Sam
S
Parnia
Asad
A
Nasir
Chirag
C
Shah
Rajeev
R
Patel
Anil
A
Mani
Paul
P
Richman
D000368:Aged; D016887:Cardiopulmonary Resuscitation; D002560:Cerebrovascular Circulation; D004632:Emergency Medical Services; D005240:Feasibility Studies; D006323:Heart Arrest / Q000097:blood* / Q000628:therapy; D006801:Humans; D010092:Oximetry / Q000295:instrumentation*; D010100:Oxygen / Q000097:blood; D019265:Spectroscopy, Near-Infrared / Q000295:instrumentation*
D010100:Oxygen