title: The relationship between cerebral regional oxygen saturation during extracorporeal cardiopulmonary resuscitation and the neurological outcome in a retrospective analysis of 16 cases.
abstract: BACKGROUND
  In recent years, the measurement of cerebral regional oxygen saturation (rSO2) during resuscitation has attracted attention. The objective of this study was to clarify the relationship between the serial changes in the cerebral rSO2values during extracorporeal cardiopulmonary resuscitation (ECPR) and the neurological outcome.
  
  
  METHODS
  We measured the serial changes in the cerebral rSO2values of patients with out-of-hospital cardiac arrest before and after ECPR in Osaka National Hospital.
  
  
  RESULTS
  From January 2013 through March 2015, the serial changes in the cerebral rSO2values were evaluated in 16 patients. Their outcomes, as measured by the Glasgow Outcome Scale (GOS) score at discharge, included good recovery (GR) (n= 4), vegetative state (VS) (n= 2), and death (D) (n= 10). In the poor neurological group (VS and D:n= 12; age, 52.8 ± 4.0 years), the cerebral rSO2values showed a significant increase during ECPR (5 min before ECPR: 52.0 ± 1.8%; 2 min before ECPR: 56.1 ± 2.3%; 2 min after ECPR: 63.5 ± 2.2%; 5 min after ECPR: 66.4 ± 2.2%; 10 min after ECPR: 67.6 ± 2.3% [P< 0.01]). In contrast, in the good neurological group (GR:n= 4; age, 53.8 ± 6.9 years), the cerebral rSO2values did not increase to a significant extent during ECPR (5 min before ECPR: 61.9 ± 3.1%; 2 min before ECPR: 57.1 ± 4.0%; 2 min after ECPR: 59.6 ± 3.8%; 5 min after ECPR: 61.0 ± 3.7%; 10 min after ECPR: 62.0 ± 3.8% [P= 0.88]). Our study suggested that the patients whose cerebral rSO2values showed no significant improvement after ECPR might have had a good neurological prognosis.
  
  
  CONCLUSIONS
  The serial changes in the cerebral rSO2values during ECPR may predict a patient's neurological outcome. The further evaluation of the validity of rSO2monitoring during ECPR may lead to a new resuscitation strategy.
authors.affiliation: Traumatology and Critical Care Medical Center, National Hospital Organization Osaka National Hospital, 2-1-14 Hoenzaka Chuo-ku, Osaka, Osaka 540-0006 Japan.
authors.forename: Naoki
authors.initials: N
authors.lastname: Ehara
authors.affiliation: Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita, Osaka 565-0871 Japan.
authors.forename: Tomoya
authors.initials: T
authors.lastname: Hirose
authors.affiliation: Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita, Osaka 565-0871 Japan.
authors.forename: Tadahiko
authors.initials: T
authors.lastname: Shiozaki
authors.affiliation: Traumatology and Critical Care Medical Center, National Hospital Organization Osaka National Hospital, 2-1-14 Hoenzaka Chuo-ku, Osaka, Osaka 540-0006 Japan.
authors.forename: Akinori
authors.initials: A
authors.lastname: Wakai
authors.affiliation: Traumatology and Critical Care Medical Center, National Hospital Organization Osaka National Hospital, 2-1-14 Hoenzaka Chuo-ku, Osaka, Osaka 540-0006 Japan.
authors.forename: Tetsuro
authors.initials: T
authors.lastname: Nishimura
authors.affiliation: Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita, Osaka 565-0871 Japan.
authors.forename: Nobuto
authors.initials: N
authors.lastname: Mori
authors.affiliation: Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita, Osaka 565-0871 Japan.
authors.forename: Mitsuo
authors.initials: M
authors.lastname: Ohnishi
authors.affiliation: Traumatology and Critical Care Medical Center, National Hospital Organization Osaka National Hospital, 2-1-14 Hoenzaka Chuo-ku, Osaka, Osaka 540-0006 Japan.
authors.forename: Daikai
authors.initials: D
authors.lastname: Sadamitsu
authors.affiliation: Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita, Osaka 565-0871 Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Shimazu
keywords: Cerebral regional oxygen saturation; Extracorporeal cardiopulmonary resuscitation; Near-infrared spectroscopy; Neurological outcome; Out-of-hospital cardiac arrest