Abstract
BACKGROUND: It has been suggested that brain tissue oxygenation (rSO2) and blood hemoglobin (Hb) at hospital arrival are independently crucial for a prognosis in post cardiac arrest syndrome (PCAS). Although it has been reported that rSO2 correlates with Hb in perioperative patients, this correlation has not been demonstrated during CPR. The product of Hb and rSO2 might represent tissue oxy-Hb level, theoretically. Therefore, it was speculated that the product during CPR predicts neurological outcome in PCAS. AIM: To investigate the relationship between the product of Hb and rSO2 on hospital arrival and good neurological outcome at 30 days in PCAS patients. METHODS: The database of the J-POP registry (multicenter observational study) has prospectively enrolled 764 OHCA patients. Of these, 193 PCAS patients admitted to the wards after ROSC were included in this study. Hb and rSO2 were obtained during resuscitation within 3 min after hospital arrival. The neurological outcome was evaluated by CPC at 30 days, and CPC1 and 2 were defined as favorable neurological outcome. RESULTS: Among 193 PCAS patients, 27 presented favorable outcome (14%) and median [IQR] of Hb and rSO2 were 12.0g/dL [10.4-13.8] and 35% [15-55]. The favorable outcome group showed higher Hb (13.8+/-2.5 vs. 11.7+/-2.7, p<0.001) and rSO2 (58.6 +/- 20.5 vs. 30.6+/-21.0, p<0.001) compared to the unfavorable group. The ROC analysis revealed the product of Hb and rSO2 significantly predicted the favorable outcome (AUC, 0.861; optimal cut-off point, 411; sensitivity, 0.917; specificity, 0.709). When divided into 4 groups by quartile of the product of Hb and rSO2 level, the ratio of patients with favorable outcome was 4.2% in the first quartile (Q1, the product<182), 4.2% in Q2 (183-257), 16.6% in Q3 (258-627), and 75.0% in Q4 (>628), respectively (chi-square test: p<0.001). CONCLUSIONS: The product of blood Hb and rSO2 level during resuscitation is a simple and excellent predictor for a 30-day neurological outcome in patients with PCAS.
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