title: Good neurological outcome despite very low regional cerebral oxygen saturation during resuscitation--a prospective preclinical trial in 29 patients.
abstract: BACKGROUND
  Noninvasive regional cerebral oxygen saturation (rSO2) measurement using near-infrared spectroscopy (NIRS) might inform on extent and duration of cerebral hypoxia during cardiopulmonary resuscitation (CPR). This information may be used to guide resuscitation efforts and may carry relevant early prognostic information.
  
  
  METHODS
  We prospectively investigated non-traumatic out-of-hospital cardiac arrest (OHCA) patients on scene. NIRS was started either during CPR or shortly after (<2 min) return of spontaneous circulation (ROSC) by emergency medical service (EMS). Outcome was determined at intensive care unit (ICU) discharge and 6 months after cardiac arrest.
  
  
  RESULTS
  A total of 29 OHCA patients were included. In 23 patients NIRS was started during CPR and in 6 patients immediately after ROSC. 18 (62.1%) patients did not reach ROSC. Initial rSO2 during CPR was very low (<50% in all 23 patients, < 30% in 19 of 23 patients) with no significant difference between patients achieving ROSC and those who did not. Of five patients with ROSC, in whom NIRS was recorded during CPR, two reached a good six-months outcome (initial rSO2 22%) and three died during the ICU stay (initial rSO2 15, 16 and 46%). In six patients with NIRS started immediately after ROSC (<2 min), rSO2 was substantially higher (54-85 %) than in patients during CPR (p = 0.006).
  
  
  CONCLUSIONS
  Initial frontal brain rSO2 determined by NIRS during CPR was generally very low and recovered rapidly after ROSC. Very low initial rSO2 during CPR was compatible with good neurological outcome in our limited cohort of patients. Further studies are needed to assess in larger cohorts and more detail the implications of very low initial rSO2 during CPR on scene.
authors.affiliation: Department of Internal Medicine, Nephrology and Intensive Care, Charité-Universitätsmedizin Berlin, Augustenburgerplatz 1, 13353, Berlin, Germany. christian.storm@charite.de.
authors.forename: Christian
authors.initials: C
authors.lastname: Storm
authors.affiliation: Department of Cardiology, Charité-Universitätsmedizin Berlin, Augustenburgerplatz 1, 13353, Berlin, Germany.
authors.forename: Alexander
authors.initials: A
authors.lastname: Wutzler
authors.affiliation: Department of Internal Medicine, Nephrology and Intensive Care, Charité-Universitätsmedizin Berlin, Augustenburgerplatz 1, 13353, Berlin, Germany.
authors.forename: Lars
authors.initials: L
authors.lastname: Trenkmann
authors.affiliation: Department of Biostatistics, Berlin Institute of Health, Clinical Research Unit, Charité-Universitätsmedizin Berlin, Augustenburgerplatz 1, 13353, Berlin, Germany.
authors.forename: Alexander
authors.initials: A
authors.lastname: Krannich
authors.affiliation: Department of Internal Medicine, Nephrology and Intensive Care, Charité-Universitätsmedizin Berlin, Augustenburgerplatz 1, 13353, Berlin, Germany.
authors.forename: Sabrina
authors.initials: S
authors.lastname: von Rheinbarben
authors.affiliation: Department of Internal Medicine, Nephrology and Intensive Care, Charité-Universitätsmedizin Berlin, Augustenburgerplatz 1, 13353, Berlin, Germany.
authors.forename: Fridolin
authors.initials: F
authors.lastname: Luckenbach
authors.affiliation: Department of Internal Medicine, Nephrology and Intensive Care, Charité-Universitätsmedizin Berlin, Augustenburgerplatz 1, 13353, Berlin, Germany.
authors.forename: Jens
authors.initials: J
authors.lastname: Nee
authors.affiliation: Department of Internal Medicine, Nephrology and Intensive Care, Charité-Universitätsmedizin Berlin, Augustenburgerplatz 1, 13353, Berlin, Germany.
authors.forename: Natalie
authors.initials: N
authors.lastname: Otto
authors.affiliation: Department of Internal Medicine, Nephrology and Intensive Care, Charité-Universitätsmedizin Berlin, Augustenburgerplatz 1, 13353, Berlin, Germany.
authors.forename: Tim
authors.initials: T
authors.lastname: Schroeder
authors.affiliation: Department of Neurology, Charité-Universitätsmedizin Berlin, Augustenburgerplatz 1, 13353, Berlin, Germany.
authors.forename: Christoph
authors.initials: C
authors.lastname: Leithner
mesh_terms: D000368:Aged; D016887:Cardiopulmonary Resuscitation / Q000379:methods*; D002560:Cerebrovascular Circulation; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D058687:Out-of-Hospital Cardiac Arrest; D017063:Outcome Assessment, Health Care; D010101:Oxygen Consumption; D011446:Prospective Studies; D019265:Spectroscopy, Near-Infrared
keywords: Cardiac arrest; Near infrared spectroscopy; Out-of-hospital cardiac arrest; Outcome