Abstract 277: Cerebral Perfusion Targeted Resuscitation: A Novel Method of Cardiac Arrest Resuscitation

Abstract

Background: A major hurdle limiting the ability to improve outcomes from cardiac arrest has been the lack of a non-invasive real-time detection system capable of monitoring the quality of cerebral and other vital organ perfusion and oxygen delivery during cardiopulmonary resuscitation (CPR). Furthermore, although, the detection of poor oxygen delivery is important, the benefits of such a system can only be realized through a system aimed at improving the quality of oxygen delivery to the brain as well as other vital organs in real-time. Here we report on the first application of such a novel system of cerebral perfusion targeted resuscitation. Method: We evaluated the role of cerebral oximetry (Equanox, Nonin, USA) as a real-time marker of cerebral perfusion and oxygen delivery in in-hospital cardiac arrest. We then evaluated the impact of perfusion targeted resuscitation by increasing real-time oxygen delivery using an automated mechanical CPR system (A-CPR) (Life Stat, Michigan Instruments, Michigan, USA) on return of spontaneous circulation (ROSC). Results: Cerebral oximetry provided real time information regarding the quality of perfusion and oxygen delivery. At baseline there was a significant difference in regional cerebral oxygen (rSO2) (mean% ±SE) in patients who achieved ROSC (n=7) compared to those without ROSC (n=15) (38%±3 vs. 22%±2 p<0.002) using conventional manual CPR (M-CPR). Furthermore at mean rSO2 below 30% nobody achieved ROSC. The use of A-CPR (n=12) led to a significant increase in rSO2 compared to M-CPR (n=22) (49%±3 vs. 27%±2 p<0.0001) as well as a significant increase in ROSC (75% vs. 45% p<0.05) reflecting the impact of improved oxygen delivery. Discussion: Real-time recognition and optimization of oxygen balance during resuscitation is critical. While further studies are needed to determine the optimal rSO2 required for longer term outcomes, the novel application of a system of continuous non-invasive real-time monitoring of the quality of oxygen delivery combined with measures aimed at improving this parameter may significantly alter the clinical practice of resuscitation by providing staff with timely information regarding the quality of cerebral oxygen delivery and the means to improve it which has so far been lacking.