A feasibility study evaluating the role of cerebral oximetry in predicting return of spontaneous circulation in cardiac arrest

Abstract

To date there has been no reliable noninvasive real time monitoring available to determine cerebral perfusion during cardiac arrest. ObjectivesTo investigate the feasibility of using a commercially available cerebral oximeter during in-hospital cardiac arrest, and determine whether this parameter predicts return of spontaneous circulation (ROSC). MethodsCerebral oximetry was incorporated in cardiac arrest management in 19 in-hospital cardiac arrest cases, five of whom had ROSC. The primary outcome measure was the relationship between rSO2 and ROSC. ResultsThe use of cerebral oximetry was found to be feasible during in hospital cardiac arrest and did not interfere with management. Patients with ROSC had a significantly higher overall mean±SE rSO2 (35±5 vs. 18±0.4, p<0.001). The difference in mean rSO2 between survivors and non-survivors was most pronounced in the final 5min of cardiac arrest (48±1 vs. 15±0.2, p<0.0001) and appeared to herald imminent ROSC. Although spending a significantly higher portion of time with an rSO2>40% was found in survivors (p<0.0001), patients with ROSC had an rSO2 above 30% for >50% of the duration of cardiac arrest, whereas non-survivors had an rSO2 that was below 30%>50% of their cardiac arrest. Patients with ROSC also had a significantly higher change in rSO2 from baseline compared to non-survivors (310%±60% vs. 150%±27%, p<0.05). ConclusionCerebral oximetry may have a role in predicting ROSC and the optimization of cerebral perfusion during cardiac arrest.