Abstract
IntroductionLittle is known about oxyhemoglobin (oxy-Hb) levels in the cerebral tissue during the development of anoxic and ischemic brain injury. We hypothesized that the estimated cerebral oxy-Hb level, a product of Hb and regional cerebral oxygen saturation (rSO2), determined at hospital arrival may reflect the level of neuroprotection in patients with post-cardiac arrest syndrome (PCAS).MethodsThe Japan Prediction of neurological Outcomes in patients with Post cardiac arrest (J-POP) registry is a prospective, multicenter, cohort study to test whether rSO2 predicts neurologic outcomes after out-of-hospital cardiac arrest (OHCA). This study assessed a subgroup of consecutive patients who fulfilled the J-POP registry criteria and successfully achieved return of spontaneous circulation (ROSC) from OHCA. The primary outcome measure was the neurologic status at 90 days.ResultsWe analyzed data from 495 consecutive comatose survivors who were successfully resuscitated from OHCA, including 119 comatose patients with prehospital return of spontaneous circulation (ROSC; 24.0%) and 376 cardiac arrests at hospital arrival. In total, 75 patients (15.1%) presented with good neurologic outcomes. Univariate analysis revealed that the cerebral oxy-Hb levels were significantly higher in patients with good outcomes. Multivariate logistic regression using the backward-elimination method confirmed that the oxy-Hb level was a significant predictor of good neurologic outcomes (adjusted odds ratio, 1.27; 95% confidence interval (CI), 1.11 to 1.46). Analysis of the area under the receiver operating characteristic curve (AUC) revealed that an oxy-Hb cut-off of 5.5 provided optimal sensitivity and specificity for predicting good neurologic outcomes (AUC, 0.87; 95% CI, 0.83 to 0.91; sensitivity, 77.3%; specificity, 85.6%). The oxy-Hb level appeared to be an excellent prognostic indicator with significant advantages over rSO2 and base excess, according to AUC analysis. The significant trend for good neurologic outcomes was consistent, even in the subgroup of patients who achieved return of spontaneous circulation on hospital arrival (1st quartile, 0; 2nd quartile, 16.7%; 3rd quartile, 29.4%; 4th quartile, 53.3%; P < 0.05).ConclusionsThe cerebral oxy-Hb level may predict neurologic outcomes and is a simple and excellent indicator of neuroprotection in patients with PCAS.Trial registrationUMIN Clinical Trials Registry UMIN000005065. Registered 1 April 2011.
Highlights
Little is known about oxyhemoglobin levels in the cerebral tissue during the development of anoxic and ischemic brain injury
Cerebral oximetry with near-infrared spectroscopy (NIRS) has been developed as a noninvasive technology that may be used for monitoring cerebral oxygen saturation during cardiac arrest [10,11,12]
General characteristics In total, 3,086 adult patients with of-hospital cardiac arrest (OHCA) were referred to the participating emergency hospitals, 1,921 of which were consecutively enrolled according to the inclusion criteria of the J-POP registry
Summary
Little is known about oxyhemoglobin (oxy-Hb) levels in the cerebral tissue during the development of anoxic and ischemic brain injury. The main objective of neurologic assessment of survivors with post–cardiac arrest syndrome (PCAS) in the acute postresuscitation period is to determine the ongoing injury and to establish the patient’s recovery from unresponsiveness [3]. The purpose of CPR is to provide effective oxygenation to the vital organs, the brain and heart, through the artificial circulation of oxyhemoglobin (oxy-Hb) until ROSC is achieved [7]. Oxy-Hb levels and cardiac output are essential determinants of oxygen delivery during ongoing CPR attempts. Little is known about oxy-Hb levels in the cerebral tissue during the development of anoxic and ischemic brain injury
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