Regional cerebral oxygen saturation monitoring for predicting interventional outcomes in patients following out-of-hospital cardiac arrest of presumed cardiac cause: A prospective, observational, multicentre study.
OBJECTIVE
This study investigated the value of regional cerebral oxygen saturation (rSO2) monitoring upon arrival at the hospital for predicting post-cardiac arrest intervention outcomes.


METHODS
We enrolled 1195 patients with out-of-hospital cardiac arrest of presumed cardiac cause from the Japan-Prediction of Neurological Outcomes in Patients Post-cardiac Arrest Registry. The primary endpoint was a good neurologic outcome (cerebral performance categories 1 or 2 [CPC1/2]) 90 days post-event.


RESULTS
A total of 68 patients (6%) had good neurologic outcomes. We found a mean rSO2 of 21%±13%. A receiver operating characteristic curve analysis indicated an optimal rSO2 cut-off of ≥40% for good neurologic outcomes (area under the curve 0.92, sensitivity 0.81, specificity 0.96). Good neurologic outcomes were observed in 53% (55/103) and 1% (13/1092) of patients with high (≥40%) and low (<40%) rSO2, respectively. Even without return of spontaneous circulation (ROSC) upon arrival at the hospital, 30% (9/30) of patients with high rSO2 had good neurologic outcomes. Furthermore, 16 patients demonstrating ROSC upon arrival at the hospital and low rSO2 had poor neurologic outcomes. Multivariate analyses indicated that high rSO2 was independently associated with good neurologic outcomes (odds ratio=14.07, P<0.001). Patients with high rSO2 showed favourable neurologic prognoses if they had undergone therapeutic hypothermia or coronary angiography (CPC1/2, 69% [54/78]). However, 24% (25/103) of those with high rSO2 did not undergo these procedures and exhibited unfavourable neurologic prognoses (CPC1/2, 4% [1/25]).


CONCLUSIONS
rSO2 is a good indicator of 90-day neurologic outcomes for post-cardiac arrest intervention patients.
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.
Kei
K
Nishiyama
Department of Cardiovascular Medicine, Kawasaki Saiwai Hospital, 31-27 Oomiyachou, Saiwai-ku, Kawasaki, Kanagawa 212-0014, Japan.
Noritoshi
N
Ito
Department of Emergency and Critical Care Medicine, Saiseikai Yokohamashi Tobu Hospital, 3-6-1 Shimosueyoshi, Tsurumi-ku, Yokohama, Kanagawa 230-0012, Japan.
Tomohiko
T
Orita
Emergency and Critical Care Medicine, Keio University School of Medicine, Shinanomachi Shinjuku-ku, Tokyo 160-8582, Japan.
Kei
K
Hayashida
Department of Emergency and Critical Care Medical Centre, Osaka City General Hospital, 2-13-22 Miyakojima Hon-Dori, Miyakojima-ku, Osaka 534-0021, Japan.
Hideki
H
Arimoto
National Hospital Organization, Kyoto Medical Centre, 1-1 Fukakusa-mukaibatakechou, Fishimi-ku, Kyoto 612-8555, Japan.
Satoru
S
Beppu
National Hospital Organization, Kyoto Medical Centre, 1-1 Fukakusa-mukaibatakechou, Fishimi-ku, Kyoto 612-8555, Japan.
Mitsuru
M
Abe
National Hospital Organization, Kyoto Medical Centre, 1-1 Fukakusa-mukaibatakechou, Fishimi-ku, Kyoto 612-8555, Japan.
Takashi
T
Unoki
Advanced Emergency Centre, Tohoku University Hospital, Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8574, Japan.
Tomoyuki
T
Endo
Department of Emergency and Critical Care Medicine, Fukuoka University Hospital, 7-45-1 Nanakuma, Jyonan-ku, Fukuoka 814-0180, Japan.
Akira
A
Murai
Critical Care Centre, Mie University Hospital, 174 Edobashi 2-chome, Tsu, Mie 514-8507, Japan.
Takeshi
T
Hatada
Advanced Critical Care Centre, Gifu University Hospital, 1-1 Yanagido, Gifu 501-1194, Japan.
Noriaki
N
Yamada
Department of Cardiology, Kyoto Katsura Hospital, 17-Banchi, Yamada Hirao-cho, Nishikyo-ku, Kyoto 615-8256, Japan.
Masahiro
M
Mizobuchi
Department of Cardiology, Fujisawa City Hospital, 2-6-1, Fujisawa, Kanagawa 251-8550, Japan.
Hideo
H
Himeno
Advanced Critical Care Centre, Nara Medical University Hospital, 840 Shijocho, Kashihara, Nara 634-8522, Japan.
Kazuo
K
Okuchi
Emergency and Critical Care Medicine, Japanese Red Cross Musashino Hospital, 1-26-1 Sakai Minami Town, Musashino, Tokyo 180-8610, Japan.
Hideto
H
Yasuda
Department of Emergency and Critical Care Medicine, St Luke's International Hospital, 9-1 Akashi-cho, Chuo-ku, Tokyo 104-8560, Japan.
Toshiaki
T
Mochizuki
Emergency and Critical Care Medicine, Seirei Hamamatsu General Hospital, 2-12-12 Sumiyoshi, Naka-ku, Hamamatsu, Shizuoka 430-8558, Japan.
Kazuhiro
K
Shiga
Department of Cardiovascular Medicine, Dokkyo Medical University, 880 Kitakobayashi, Mibu-machi, Shimotsuga-gun, Tochigi 321-0293, Japan.
Migaku
M
Kikuchi
Department of Health Informatics, Kyoto University School of Public Health, Yoshida-Konoe-cho, Sakyo-ku, Kyoto 606-8501, Japan.
Yuka
Y
Tsujimura
Emergency Life Saving Technique Academy, 3-8-1 Oura, Yahata-nishi-ku, Kitakyushu, Fukuoka 807-0874, Japan.
Tetsuo
T
Hatanaka
Department of Cardiology, Surugadai Nihon University Hospital, 1-8-13 Kanda-Surugadai, Chiyoda-ku, Tokyo 101-8309, Japan.
Ken
K
Nagao
D000368:Aged; D001921:Brain / Q000378:metabolism* / Q000503:physiopathology; D016887:Cardiopulmonary Resuscitation / Q000379:methods*; D002560:Cerebrovascular Circulation / Q000502:physiology*; D005260:Female; D005500:Follow-Up Studies; D006331:Heart Diseases / Q000150:complications* / Q000378:metabolism; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008297:Male; D058687:Out-of-Hospital Cardiac Arrest / Q000150:complications / Q000401:mortality / Q000628:therapy*; D010092:Oximetry; D010100:Oxygen / Q000378:metabolism*; D010101:Oxygen Consumption / Q000502:physiology*; D011379:Prognosis; D011446:Prospective Studies; D019265:Spectroscopy, Near-Infrared / Q000379:methods; D015996:Survival Rate
D010100:Oxygen
Cardiac arrest; Cardiopulmonary resuscitation; Cerebrovascular circulation; Oxygen; Prognoses