title: Cerebral Oximetry During Cardiac Arrest: A Multicenter Study of Neurologic Outcomes and Survival.
abstract: OBJECTIVE
  Cardiac arrest is associated with morbidity and mortality because of cerebral ischemia. Therefore, we tested the hypothesis that higher regional cerebral oxygenation during resuscitation is associated with improved return of spontaneous circulation, survival, and neurologic outcomes at hospital discharge. We further examined the validity of regional cerebral oxygenation as a test to predict these outcomes.
  
  
  METHODS
  Multicenter prospective study of in-hospital cardiac arrest.
  
  
  METHODS
  Five medical centers in the United States and the United Kingdom.
  
  
  METHODS
  Inclusion criteria are as follows: in-hospital cardiac arrest, age 18 years old or older, and prolonged cardiopulmonary resuscitation greater than or equal to 5 minutes. Patients were recruited consecutively during working hours between August 2011 and September 2014. Survival with a favorable neurologic outcome was defined as a cerebral performance category 1-2.
  
  
  METHODS
  Cerebral oximetry monitoring.
  
  
  RESULTS
  Among 504 in-hospital cardiac arrest events, 183 (36%) met inclusion criteria. Overall, 62 of 183 (33.9%) achieved return of spontaneous circulation, whereas 13 of 183 (7.1%) achieved cerebral performance category 1-2 at discharge. Higher mean ± SD regional cerebral oxygenation was associated with return of spontaneous circulation versus no return of spontaneous circulation (51.8% ± 11.2% vs 40.9% ± 12.3%) and cerebral performance category 1-2 versus cerebral performance category 3-5 (56.1% ± 10.0% vs 43.8% ± 12.8%) (both p < 0.001). Mean regional cerebral oxygenation during the last 5 minutes of cardiopulmonary resuscitation best predicted the return of spontaneous circulation (area under the curve, 0.76; 95% CI, 0.69-0.83); regional cerebral oxygenation greater than or equal to 25% provided 100% sensitivity (95% CI, 94-100) and 100% negative predictive value (95% CI, 79-100); regional cerebral oxygenation greater than or equal to 65% provided 99% specificity (95% CI, 95-100) and 93% positive predictive value (95% CI, 66-100) for return of spontaneous circulation. Time with regional cerebral oxygenation greater than 50% during cardiopulmonary resuscitation best predicted cerebral performance category 1-2 (area under the curve, 0.79; 95% CI, 0.70-0.88). Specifically, greater than or equal to 60% cardiopulmonary resuscitation time with regional cerebral oxygenation greater than 50% provided 77% sensitivity (95% CI,:46-95), 72% specificity (95% CI, 65-79), and 98% negative predictive value (95% CI, 93-100) for cerebral performance category 1-2.
  
  
  CONCLUSIONS
  Cerebral oximetry allows real-time, noninvasive cerebral oxygenation monitoring during cardiopulmonary resuscitation. Higher cerebral oxygenation during cardiopulmonary resuscitation is associated with return of spontaneous circulation and neurologically favorable survival to hospital discharge. Achieving higher regional cerebral oxygenation during resuscitation may optimize the chances of cardiac arrest favorable outcomes.
authors.affiliation: 1Resuscitation Research Group, State University of New York at Stony Brook, Stony Brook, NY.2Department of Resuscitation Services, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom3NIHR Respiratory BRU, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom.4Department of Anaesthesia and Critical Care, Queen Alexandra Hospital, Portsmouth, United Kingdom.5Centre for Peri-Operative Medicine and Critical Care Research, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, United Kingdom.6Department of Critical Care Medicine, Warwick Medical School and Heart of England NHS Foundation Trust, Birmingham, United Kingdom.7Department of Anaesthesia and Critical Care, Royal United Hospital, Bath, United Kingdom.
authors.forename: Sam
authors.initials: S
authors.lastname: Parnia
authors.forename: Jie
authors.initials: J
authors.lastname: Yang
authors.forename: Robert
authors.initials: R
authors.lastname: Nguyen
authors.forename: Anna
authors.initials: A
authors.lastname: Ahn
authors.forename: Jiawen
authors.initials: J
authors.lastname: Zhu
authors.forename: Loren
authors.initials: L
authors.lastname: Inigo-Santiago
authors.forename: Asad
authors.initials: A
authors.lastname: Nasir
authors.forename: Kim
authors.initials: K
authors.lastname: Golder
authors.forename: Shreyas
authors.initials: S
authors.lastname: Ravishankar
authors.forename: Pauline
authors.initials: P
authors.lastname: Bartlett
authors.forename: Jianjin
authors.initials: J
authors.lastname: Xu
authors.forename: David
authors.initials: D
authors.lastname: Pogson
authors.forename: Sarah
authors.initials: S
authors.lastname: Cooke
authors.forename: Christopher
authors.initials: C
authors.lastname: Walker
authors.forename: Ken
authors.initials: K
authors.lastname: Spearpoint
authors.forename: David
authors.initials: D
authors.lastname: Kitson
authors.forename: Teresa
authors.initials: T
authors.lastname: Melody
authors.forename: Mehboob
authors.initials: M
authors.lastname: Chilwan
authors.forename: Elinor
authors.initials: E
authors.lastname: Schoenfeld
authors.forename: Paul
authors.initials: P
authors.lastname: Richman
authors.forename: Barbara
authors.initials: B
authors.lastname: Mills
authors.forename: Nancy
authors.initials: N
authors.lastname: Wichtendahl
authors.forename: Jerry
authors.initials: J
authors.lastname: Nolan
authors.forename: Adam
authors.initials: A
authors.lastname: Singer
authors.forename: Stephen
authors.initials: S
authors.lastname: Brett
authors.forename: Gavin D
authors.initials: GD
authors.lastname: Perkins
authors.forename: Charles D
authors.initials: CD
authors.lastname: Deakin
mesh_terms: D000368:Aged; D002545:Brain Ischemia / Q000175:diagnosis* / Q000209:etiology / Q000401:mortality; D016887:Cardiopulmonary Resuscitation; D002560:Cerebrovascular Circulation / Q000502:physiology*; D005260:Female; D006323:Heart Arrest / Q000401:mortality / Q000503:physiopathology* / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010092:Oximetry; D010351:Patient Discharge; D011237:Predictive Value of Tests; D011446:Prospective Studies; D015996:Survival Rate; D016896:Treatment Outcome; D006113:United Kingdom; D014481:United States