Abstract 17993: Bystander-Initiated Cardiopulmonary Resuscitation Can Maintain Regional Cerebral Oxygen Saturation Levels on Hospital Arrival in Patients with Refractory Out-of-Hospital Cardiac Arrest

Abstract

Background: Bystander-initiated cardiopulmonary resuscitation (B-CPR) plays a key role in the chain of survival for out-of-hospital cardiac arrest (OHCA) patients. We have previously reported that a low regional cerebral oxygen saturation (rSO2) level is a strong predictor of poor neurological outcome in OHCA patients. Objectives: To assess the association between B-CPR and rSO2 levels measured immediately on hospital arrival. Methods: This study was a prospective cohort study. Of 418 OHCA patients, 186 consecutive non-traumatic, cardiac arrest on arrival (CAOA) patients were prospectively registered. The rSO2 levels were measured with sensors placed on either side of their forehead using a near-infrared spectroscopy (NIRS) device (INVOS, Covidien, US) within 3 minutes after hospital arrival. We monitored rSO2 levels at least for more than one minute and used the lower of the 2 measured rSO2 levels for analysis. Clinical staff performed ordinary post-cardiac-arrest interventions (PCAIs) regardless of rSO2 levels. Primary outcome measure was good neurological outcome (CPC 1/2) at hospital discharge according to the “Utstein-style”. After dividing the eligible 186 patients into the two groups (B-CPR group (n=76) and no B-CPR group (n=110)), we compared the rSO2 levels on hospital arrival and the neurological outcome between the two groups. Results: Among 186 CAOA patients in PCAIs era, 18 patients (9.7%) had good neurological outcome. The B-CPR group patients had more maintained rSO2 levels on hospital arrival with a much higher proportion of good neurological outcome as compared with the no B-CPR group patients (33±20% vs. 22±13%, p=0.00003; 21% vs. 2%, p=0.00005, respectively). Conclusion: The findings suggest that B-CPR for CAOA patients after OHCA contributes to maintaining the rSO2 levels on hospital arrival and improving neurological outcome at hospital discharge even in the PCAIs era.