Abstract
Objective: To clarify the neurological prognosis of post-resuscitation hypoxic encephalopathy patients on the basis of cerebral autoregulation. Methods: We conducted a prospective, observational cohort study of patients admitted to our urban emergency and critical care center in Japan between 2017 and 2019. Cerebral regional oxygen saturation (rSO 2 ) was measured in patients with cardiopulmonary arrest on hospital arrival or return of spontaneous circulation (ROSC) before hospital arrival. Included in the analysis were patients aged ≥16 years who were transported to our hospital. Patients dying within 24 h of hospitalization were excluded. Immediately after arrival, the cerebral rSO 2 sensor was attached to the patient’s forehead and continuous monitoring was started. Continuous monitoring of cerebral rSO 2 and mean arterial pressure (MAP) was conducted until extubation or 96 hours after ROSC. We divided the patients into the good neurological prognosis group (cerebral performance category: CPC 1, 2) and poor neurological prognosis group (CPC 3-5) and compared them. Results: Among the 37 patients with a mean age (± SD) of 68.9 (± 14.8) years, 12 had a good neurological prognosis and 25 had a poor neurological prognosis. In the good neurological cases, we found that the cerebral rSO 2 value showed biphasic changes followed by a long plateau around the lower limit of the normal rSO 2 range from 12 h after ROSC. However, in the poor neurological prognosis cases, we observed that the cerebral rSO 2 value was unstable. In addition, our data showed that the cerebral rSO 2 values in the good neurological prognosis cases remained almost constant even if MAP changed (Figure). Conclusions: We observed the transition of cerebral rSO 2 and its characteristics after resuscitation in cases with good neurological prognosis. Focusing on the cerebral autoregulation may be useful to predict neurological prognosis in post-resuscitation hypoxic encephalopathy.
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