Abstract 14016: Severity Assessment of Brain Damage With rSO2 monitoring for Extracorporeal Cardiopulmonary Resuscitation After Out-of-hospital Cardiac Arrest

Abstract

Introduction: Decisions regarding extracorporeal cardiopulmonary resuscitation (E-CPR) for patients after out-of-hospital cardiac arrest (OHCA) are difficult to make. Hypothesis: We hypothesized that regional brain oxygen saturation (rSO2) value monitoring in the emergency room was useful for speculating on brain damage severity for prognostication for E-CPR after OHCA. Methods: The J-POP registry is a prospective multicenter cohort study to test whether rSO2 predicts neurological outcomes after nontraumatic OHCA. We measured rSO2 values in OHCA patients immediately after hospital arrival with a near-infrared spectrometer placed on the forehead. The primary endpoint was neurological outcome (cerebral performance category: 1, 2) 90 days after OHCA. Results: We consecutively enrolled 1,921 OHCA patients. After 90 days, 79 (4%) patients had good neurological outcomes and a median lower rSO2 level of 15% (95% confidence interval (CI): 15-20%). Receiver operating curve analysis indicated an optimal rSO2 cutoff point was about 40% for predicting good neurological outcome (area under curve = 0.91 [95% CI: 0.90 - 0.92], P < 0.01). Compared to patients without return of spontaneous circulation (ROSC) upon arrival at the hospital, those with ROSC had significantly higher rSO2 levels (56% [95% CI: 39-65%] vs. 15% [95% CI: 15-17%], respectively; P < 0.01). In patients without ROSC upon arrival at the hospital (n=1773), the percentage of patients with a good 90-day neurological outcome increased significantly in proportion to their rSO2 levels upon arrival at the hospital (P < 0.01, Figure). In patients with E-CPR (n=121), the percentage of patients with a good 90-day neurological outcome increased significantly if their rSO2 levels upon arrival at the hospital was >40% (5/16, 31% vs 6/105, 6%, P < 0.01). Conclusions: rSO2 value monitoring in the emergency room was useful for speculating on brain damage severity for prognostication for E-CPR after OHCA.