Abstract
Introduction: The simplified monitoring of regional cerebral oxygen saturation (rSO 2 ) is a non-invasive method of measuring cerebral perfusion, but continuous changes in the cerebral rSO 2 values among OHCA patients in the pre-hospital settings have not been sufficiently investigated. Our objective is to investigate the association between the change in rSO 2 pattern and patient outcome. Methods: We recently developed a very small portable rSO 2 monitoring system that can be used in the pre-hospital setting. The system can monitor cerebral rSO 2 immediately after attachment; monitoring is performed continuously during CPR. The system was used from June 2013 to May 2019 in Osaka City, Japan.The primary outcome measure was neurologically intact survival at 1 month. Results: We collected the continuous changes in the cerebral rSO 2 values of 87 OHCA patients during CPR by EMS personnel. The analyses of the continuous changes in the rSO 2 values of the 79 cases in which the rSO 2 value was measured before ROSC revealed two patterns of changes in the cerebral rSO 2 values. In type 1 (increasing rSO 2 type; n=38), the measured rSO 2 gradually increased during CPR or after ROSC. There were 3 patients of neurologically intact survival in type 1. In type 2 (non-increasing rSO 2 type; n=41), the measured rSO 2 did not increase during CPR. There was no patient of neurologically intact survival in type 2. We found an instructive phenomenon in the changes of the cerebral rSO 2 values. Measured rSO 2 dropped after confirmation of ROSC, which suggests that re-arrest had occurred during monitoring. Conclusion: We measured the continuous changes in cerebral rSO 2 values among 87 patients with OHCA in the pre-hospital setting and found 2 patterns and an instructive phenomenon in the continuous changes in rSO 2 values. Increasing type rSO 2 during CPR appeared to be associated with neurologically intact survival at 1 month.
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