title: Cerebral Oximetry as a Real-Time Monitoring Tool to Assess Quality of In-Hospital Cardiopulmonary Resuscitation and Post Cardiac Arrest Care.
abstract: BACKGROUND
  Regional cerebral oxygen saturation (rSO2) as assessed by near infrared frontal cerebral spectroscopy decreases in circulatory arrest and increases with high-quality cardiopulmonary resuscitation. We hypothesized that higher rSO2 during cardiopulmonary resuscitation and after return of spontaneous circulation (ROSC) would predict survival to discharge and neurological recovery.
  
  
  RESULTS
  This prospective case series included patients experiencing in-hospital cardiac arrest. Cerebral oximetry was recorded continuously from initiation of resuscitation until ROSC and up to 48 hours post-arrest. Relationships between oximetry data during these time periods and outcomes of resuscitation survival and survival to discharge were analyzed. The cohort included 27 patients. Nineteen (70.3%) achieved ROSC, and 8 (29.6%) survived to discharge. Median arrest duration was 20.8 minutes (range=8 to 74). There was a significant difference in rSO2 between resuscitation survivors and resuscitation nonsurvivors at initiation of the resuscitative efforts (35% versus 17.5%, P=0.03) and during resuscitation (36% versus 15%, P=0.0008). No significant association was observed between rSO2 at ROSC or during the post-arrest period and survival to discharge. Among patients who survived to discharge, there was no association between cerebral performance category and rSO2 at ROSC, during resuscitation, or post-arrest.
  
  
  CONCLUSIONS
  Higher rSO2 levels at initiation of resuscitation and during resuscitation are associated with resuscitation survival and may reflect high-quality cardiopulmonary resuscitation. However, in this small series, rSO2 was not predictive of good neurological outcome. Larger studies are needed to determine whether this monitoring modality can be used to improve clinical outcomes.
authors: Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA (A.W.I., N.W.D., M.Z.) Atlanta Veterans Administration Medical Center, Decatur, GA (A.W.I., K.B., E.O., D.H., H.L.M., C.T., D.C., R.P., N.W.D., M.Z.).
authors: Akram W
authors: AW
authors: Ibrahim
authors: Division of General Medicine and Geriatrics, Department of Medicine, Emory University School of Medicine, Atlanta, GA (A.R.T.) Grady Memorial Hospital, Atlanta, GA (A.R.T.).
authors: Antoine R
authors: AR
authors: Trammell
authors: Emory University Rollins School of Public Health, Atlanta, GA (H.A., N.W.D.).
authors: Harland
authors: H
authors: Austin
authors: Atlanta Veterans Administration Medical Center, Decatur, GA (A.W.I., K.B., E.O., D.H., H.L.M., C.T., D.C., R.P., N.W.D., M.Z.).
authors: Kenya
authors: K
authors: Barbour
authors: Atlanta Veterans Administration Medical Center, Decatur, GA (A.W.I., K.B., E.O., D.H., H.L.M., C.T., D.C., R.P., N.W.D., M.Z.).
authors: Emeka
authors: E
authors: Onuorah
authors: Atlanta Veterans Administration Medical Center, Decatur, GA (A.W.I., K.B., E.O., D.H., H.L.M., C.T., D.C., R.P., N.W.D., M.Z.).
authors: Dorothy
authors: D
authors: House
authors: Atlanta Veterans Administration Medical Center, Decatur, GA (A.W.I., K.B., E.O., D.H., H.L.M., C.T., D.C., R.P., N.W.D., M.Z.).
authors: Heather L
authors: HL
authors: Miller
authors: Atlanta Veterans Administration Medical Center, Decatur, GA (A.W.I., K.B., E.O., D.H., H.L.M., C.T., D.C., R.P., N.W.D., M.Z.).
authors: Chandila
authors: C
authors: Tutt
authors: Atlanta Veterans Administration Medical Center, Decatur, GA (A.W.I., K.B., E.O., D.H., H.L.M., C.T., D.C., R.P., N.W.D., M.Z.).
authors: Deborah
authors: D
authors: Combs
authors: Atlanta Veterans Administration Medical Center, Decatur, GA (A.W.I., K.B., E.O., D.H., H.L.M., C.T., D.C., R.P., N.W.D., M.Z.).
authors: Roger
authors: R
authors: Phillips
authors: Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA (A.W.I., N.W.D., M.Z.) Emory University Rollins School of Public Health, Atlanta, GA (H.A., N.W.D.) Atlanta Veterans Administration Medical Center, Decatur, GA (A.W.I., K.B., E.O., D.H., H.L.M., C.T., D.C., R.P., N.W.D., M.Z.).
authors: Neal W
authors: NW
authors: Dickert
authors: Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA (A.W.I., N.W.D., M.Z.) Atlanta Veterans Administration Medical Center, Decatur, GA (A.W.I., K.B., E.O., D.H., H.L.M., C.T., D.C., R.P., N.W.D., M.Z.).
authors: A Maziar
authors: AM
authors: Zafari
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D016507:Cardiology Service, Hospital / Q000592:standards*; D016887:Cardiopulmonary Resuscitation / Q000009:adverse effects / Q000401:mortality / Q000592:standards*; D002560:Cerebrovascular Circulation; D005260:Female; D006323:Heart Arrest / Q000097:blood / Q000175:diagnosis* / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D017052:Hospital Mortality; D006801:Humans; D007297:Inpatients; D008297:Male; D008875:Middle Aged; D010092:Oximetry / Q000379:methods / Q000592:standards*; D010100:Oxygen / Q000097:blood*; D010351:Patient Discharge; D011237:Predictive Value of Tests; D011446:Prospective Studies; D019984:Quality Indicators, Health Care / Q000592:standards*; D020127:Recovery of Function; D019265:Spectroscopy, Near-Infrared / Q000592:standards*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D010100:Oxygen
keywords: cardiac arrest; cerebral oximetry; research methods