Division of Cardiothoracic and Vascular Anaesthesia and Intensive Care Medicine, Department of Anaesthesia, Intensive Care Medicine and Pain Medicine, Medical University of Vienna, Vienna General Hospital, Austria; Department of Emergency Medicine, Medical University of Vienna, Vienna General Hospital, Austria.
Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna General Hospital, Austria.
Resuscitation. 2018 Apr;125:39-47. doi: 10.1016/j.resuscitation.2018.01.028. Epub 2018 Feb 2.
Regional cerebral oxygen saturation (rSO2) can be measured non-invasively even at no- or low-flow states. It thus allows assessment of brain oxygenation during CPR. Certain rSO2 values had been associated with return of spontaneous circulation (ROSC) and neurological outcome in the past. Clear-cut thresholds for the prediction of beneficial outcome, however, are still lacking.
We conducted a database search to extract all available investigations on rSO2 measurement during CPR. Mean, median, and ΔrSO2 values were either taken from the studies or calculated. Thresholds for the outcome "ROSC" and "neurological outcome" were sought.
We retrieved 26 publications for the final review. The averaged mean rSO2 for patients achieving ROSC was 41 ± 12% vs. 30 ± 12% for non-ROSC (p = .009). ROSC was not observed when mean rSO2 remained <26%. In ROSC patients, ΔrSO2 was 22 ± 16% vs. 7 ± 10% in non-ROSC patients (p = .009). A rSO2 threshold of 36% predicted ROSC with a sensitivity of 67% and specificity of 69% while ΔrSO2 of 7% showed a sensitivity of 100% and a specificity of 86% (AUC = 0.733 and 0.893, respectively). Mean rSO2 of 47 ± 11% was associated with favourable and 38 ± 12% with poor neurological outcome. There was, however, a great overlap between groups due to scarce data.
Higher rSO2 consistently correlated with increased rates of ROSC. The discriminatory power of rSO2 to prognosticate favourable neurological outcome remains unclear. Measuring rSO2 during CPR could potentially facilitate clinical decision-making.
区域脑氧饱和度（rSO2）可在无血流或低血流状态下进行非侵入性测量。因此，它可以评估心肺复苏期间的脑氧合情况。过去，某些 rSO2 值与自主循环恢复（ROSC）和神经功能预后相关。然而，目前仍缺乏明确的预测有利结局的阈值。
我们进行了数据库检索，以提取所有关于心肺复苏期间 rSO2 测量的可用研究。均值、中位数和 rSO2 差值是从研究中获取或计算得出的。寻找预测“ROSC”和“神经功能预后”的阈值。
我们最终回顾了 26 篇文献。达到 ROSC 的患者的平均 rSO2 为 41±12%，而非 ROSC 的患者为 30±12%（p=0.009）。当平均 rSO2 持续<26%时，未观察到 ROSC。在 ROSC 患者中，rSO2 差值为 22±16%，而非 ROSC 患者为 7±10%（p=0.009）。rSO2 阈值为 36%时，预测 ROSC 的敏感性为 67%，特异性为 69%，而 rSO2 差值为 7%时，敏感性为 100%，特异性为 86%（AUC 分别为 0.733 和 0.893）。平均 rSO2 为 47±11%与良好的神经功能预后相关，而 38±12%与不良的神经功能预后相关。然而，由于数据稀缺，两组之间存在很大的重叠。
较高的 rSO2 与 ROSC 发生率的增加一致相关。rSO2 预测有利神经功能预后的区分能力仍不清楚。在心肺复苏期间测量 rSO2 可能有助于临床决策。
