title: Noninvasive regional cerebral oxygen saturation for neurological prognostication of patients with out-of-hospital cardiac arrest: a prospective multicenter observational study.
abstract: OBJECTIVE
  To investigate the association between regional brain oxygen saturation (rSO2) at hospital arrival and neurological outcomes at 90 days in patients with out-of-hospital cardiac arrest (OHCA).
  
  
  METHODS
  The Japan-Prediction of neurological Outcomes in patients post cardiac arrest (J-POP) registry is a prospective, multicenter, cohort study to test whether rSO2 predicts neurological outcomes after OHCA. We measured rSO2 in OHCA patients immediately after hospital arrival using a near-infrared spectrometer placed on the forehead with non-blinded fashion. The primary endpoint was "neurological outcomes" at 90 days after OHCA.
  
  
  RESULTS
  EMS providers are not permitted to terminate CPR in the field in Japan, and so most patients with OHCA who are treated by EMS personnel are transported to emergency hospitals. Among 1017 OHCA patients, 672 patients including 52 comatose patients with pulses detectable (8%) and 620 cardiac arrest patients (92%) at hospital arrival were enrolled prospectively and consecutively. Twenty-nine patients with good neurological outcome had a significantly higher value of rSO2 at hospital arrival than 643 patients with poor neurological outcome (mean [±SD] 55.6±20.8% vs. 19.7±11.0%, p<0.001). Receiver operating curve analysis indicated an optimal rSO2 cutoff point of >42% for predicting good neurological outcome, with sensitivity 0.79 (95% confidence interval [CI], 0.60-0.92), specificity 0.95 (95% CI, 0.93-0.96), positive predictive value, 0.41 (95% CI, 0.28-0.55), negative predictive value, 0.99 (95% CI, 0.98-1.00), and area under the curve 0.90 (95% CI, 0.88-0.92).
  
  
  CONCLUSIONS
  The rSO2 at hospital arrival can predict good neurological outcome at 90 days after OHCA.
authors.affiliation: Senri Cardiovascular Center, Osaka Saiseikai Senri Hospital, 1-1-6 Tsukumodai, Suita, Osaka 565-0862, Japan; Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan.
authors.forename: Noritoshi
authors.initials: N
authors.lastname: Ito
authors.affiliation: 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.
authors.forename: Kei
authors.initials: K
authors.lastname: Nishiyama
authors.affiliation: Department of Emergency Medicine, University of Pittsburgh, Iroquois Building, Suite 400A, 3600 Forbes Avenue, Pittsburgh, PA 15261, United States.
authors.forename: Clifton W
authors.initials: CW
authors.lastname: Callaway
authors.affiliation: Department of Emergency and Critical Care Medicine, Saiseikai Yokohamashi Tobu Hospital, 3-6-1 Shimosueyoshi, Tsurumi-ku, Yokohama, Kanagawa 230-0012, Japan.
authors.forename: Tomohiko
authors.initials: T
authors.lastname: Orita
authors.affiliation: Emergency and Critical Care Medicine, Keio University School of Medicine, 35 Shinanomachi Shinjuku-ku, Tokyo 160-8582, Japan.
authors.forename: Kei
authors.initials: K
authors.lastname: Hayashida
authors.affiliation: Department of Emergency and Critical Care Medical Center, Osaka City General Hospital, 2-13-22 Miyakojima Hon-Dori, Miyakojima-ku, Osaka 534-0021, Japan.
authors.forename: Hideki
authors.initials: H
authors.lastname: Arimoto
authors.affiliation: Department of Cardiology, National Hospital Organization Kyoto Medical Center, 1-1 Fukakusamukaihatachou, Fushimi-ku, Kyoto 612-8555, Japan.
authors.forename: Mitsuru
authors.initials: M
authors.lastname: Abe
authors.affiliation: Advanced Emergency Center, Tohoku University Hospital, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8574, Japan.
authors.forename: Tomoyuki
authors.initials: T
authors.lastname: Endo
authors.affiliation: Department of Emergency and Critical Care Medicine, Fukuoka University Hospital, 7-45-1 Nanakuma, Jyonan-ku, Fukuoka 814-0180, Japan.
authors.forename: Akira
authors.initials: A
authors.lastname: Murai
authors.affiliation: Critical Care Center, Mie University Hospital, 174 Edobashi 2-chome, Tsu, Mie 514-8507, Japan.
authors.forename: Ken
authors.initials: K
authors.lastname: Ishikura
authors.affiliation: Advanced Critical Care Center, Gifu University Hospital, 1-1 Yanagido, Gifu 501-1194, Japan.
authors.forename: Noriaki
authors.initials: N
authors.lastname: Yamada
authors.affiliation: Department of Cardiology, Kyoto Katsura Hospital, 17-Banchi, Yamada Hirao-cho, Nishikyo-ku, Kyoto 615-8256, Japan.
authors.forename: Masahiro
authors.initials: M
authors.lastname: Mizobuchi
authors.affiliation: Division of Emergency Medicine, Fujisawa City Hospital, 2-6-1 Fujisawa, Kanagawa 251-8550, Japan.
authors.forename: Hideki
authors.initials: H
authors.lastname: Anan
authors.affiliation: Advanced Critical Care Center, Nara Medical University Hospital, 840 Shijocho, Kashihara, Nara 634-8522, Japan.
authors.forename: Kazuo
authors.initials: K
authors.lastname: Okuchi
authors.affiliation: Emergency and Critical Care Medicine, Japanese Red Cross Musashino Hospital, 1-26-1 Sakai Minami Town, Musashino, Tokyo 180-8610, Japan.
authors.forename: Hideto
authors.initials: H
authors.lastname: Yasuda
authors.affiliation: Department of Emergency and Critical Care Medicine St Luke's International Hospital, 9-1 Akashi-cho, Chuo-ku, Tokyo 104-8560, Japan.
authors.forename: Toshiaki
authors.initials: T
authors.lastname: Mochizuki
authors.affiliation: Department of Health Informatics, Kyoto University School of Public Health, Yoshida-Konoe-cho, Sakyo-ku, Kyoto 606-8501, Japan.
authors.forename: Yuka
authors.initials: Y
authors.lastname: Tsujimura
authors.affiliation: Department of Health Informatics, Kyoto University School of Public Health, Yoshida-Konoe-cho, Sakyo-ku, Kyoto 606-8501, Japan.
authors.forename: Takeo
authors.initials: T
authors.lastname: Nakayama
authors.affiliation: Emergency Life Saving Technique Academy, 3-8-1 Oura, Yahata-nishi-ku, Kitakyushu, Fukuoka 807-0874, Japan.
authors.forename: Tetsuo
authors.initials: T
authors.lastname: Hatanaka
authors.affiliation: Department of Cardiology, Surugadai Nihon University Hospital, 1-8-13 Kanda-Surugadai, Chiyoda-ku, Tokyo 101-8309, Japan.
authors.forename: Ken
authors.initials: K
authors.lastname: Nagao
mesh_terms: D000368:Aged; D001921:Brain / Q000378:metabolism*; D001927:Brain Diseases / Q000175:diagnosis* / Q000209:etiology / Q000378:metabolism*; D003943:Diagnostic Techniques, Neurological; D005260:Female; D006801:Humans; D008297:Male; D058687:Out-of-Hospital Cardiac Arrest / Q000150:complications / Q000378:metabolism*; D010100:Oxygen / Q000378:metabolism*; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D019265:Spectroscopy, Near-Infrared
chemical_list: D010100:Oxygen
keywords: Cardiac arrest; Cardiopulmonary resuscitation; Emergency department; Predictors; Regional brain oxygen saturation