Abstract
BackgroundIn recent years, the measurement of cerebral regional oxygen saturation (rSO2) during resuscitation has attracted attention. The objective of this study was to clarify the relationship between the serial changes in the cerebral rSO2 values during extracorporeal cardiopulmonary resuscitation (ECPR) and the neurological outcome.MethodsWe measured the serial changes in the cerebral rSO2 values of patients with out-of-hospital cardiac arrest before and after ECPR in Osaka National Hospital.ResultsFrom January 2013 through March 2015, the serial changes in the cerebral rSO2 values were evaluated in 16 patients. Their outcomes, as measured by the Glasgow Outcome Scale (GOS) score at discharge, included good recovery (GR) (n = 4), vegetative state (VS) (n = 2), and death (D) (n = 10). In the poor neurological group (VS and D: n = 12; age, 52.8 ± 4.0 years), the cerebral rSO2 values showed a significant increase during ECPR (5 min before ECPR: 52.0 ± 1.8%; 2 min before ECPR: 56.1 ± 2.3%; 2 min after ECPR: 63.5 ± 2.2%; 5 min after ECPR: 66.4 ± 2.2%; 10 min after ECPR: 67.6 ± 2.3% [P < 0.01]). In contrast, in the good neurological group (GR: n = 4; age, 53.8 ± 6.9 years), the cerebral rSO2 values did not increase to a significant extent during ECPR (5 min before ECPR: 61.9 ± 3.1%; 2 min before ECPR: 57.1 ± 4.0%; 2 min after ECPR: 59.6 ± 3.8%; 5 min after ECPR: 61.0 ± 3.7%; 10 min after ECPR: 62.0 ± 3.8% [P = 0.88]). Our study suggested that the patients whose cerebral rSO2 values showed no significant improvement after ECPR might have had a good neurological prognosis.ConclusionsThe serial changes in the cerebral rSO2 values during ECPR may predict a patient’s neurological outcome. The further evaluation of the validity of rSO2 monitoring during ECPR may lead to a new resuscitation strategy.
Highlights
In recent years, the measurement of cerebral regional oxygen saturation during resuscitation has attracted attention
Recently, a systematic review and meta-analysis reported by Sanfilippo et al [10] showed that higher initial and average cerebral rSO2 values were both associated with a greater chance of achieving an return of spontaneous circulation (ROSC) in patients with cardiac arrest; they could not show a relationship between the cerebral rSO2 value and the neurological outcome of patients resuscitated from cardiac arrest
The results of this study suggested that the patients whose cerebral rSO2 values did not show a significant improvement after extracorporeal cardiopulmonary resuscitation (ECPR) might have had a good neurological prognosis (Figs. 1b and 2)
Summary
The measurement of cerebral regional oxygen saturation (rSO2) during resuscitation has attracted attention. The objective of this study was to clarify the relationship between the serial changes in the cerebral rSO2 values during extracorporeal cardiopulmonary resuscitation (ECPR) and the neurological outcome. The measurement of cerebral regional oxygen saturation (rSO2) by near-infrared spectroscopy (NIRS) during resuscitation has attracted attention. We have already reported the serial changes in the cerebral rSO2 values during resuscitation in patients with OHCA [3]. The cerebral rSO2 value increased promptly after the initiation of extracorporeal cardiopulmonary resuscitation (ECPR) [4]. We could not predict the neurological outcome by evaluating the cerebral rSO2 value in patients with OHCA in 2010 [4]
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