Department of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium; Department of Anaesthesiology, Intensive Care, Emergency Medicine and Pain Therapy, Ziekenhuis Oost-Limburg, Genk, Belgium; Schiepse Bos 6, 3600, Genk, Belgium.
Emergency Department, Ziekenhuis Netwerk Antwerpen, Campus Stuivenberg, Lange Beeldekensstraat 267, 2060, Antwerpen, Belgium.
Resuscitation. 2018 Aug;129:107-113. doi: 10.1016/j.resuscitation.2018.03.031. Epub 2018 Mar 23.
To date, monitoring options during pre-hospital advanced life support (ALS) are limited. Regional cerebral saturation (rSO) may provide more information concerning the brain during ALS. We hypothesized that an increase in rSO during ALS in out-of hospital cardiac arrest (OHCA) patients is associated with return of spontaneous circulation (ROSC).
A prospective, non-randomized multicenter study was conducted in the pre-hospital setting of six hospitals in Belgium. Cerebral saturation was measured during pre-hospital ALS by a medical emergency team in OHCA patients. Cerebral saturation was continuously measured until ALS efforts were terminated or until the patient with sustained ROSC (>20 min) arrived at the emergency department. To take the longitudinal nature of the data into account, a linear mixed model was used. The correlation between the repeated measures of a patient was handled by means of a random intercept and a random slope. Our primary analysis tested the association of rSO with ROSC.
Of the 329 patients 110 (33%) achieved ROSC. First measured rSO was 30% ± 18 in the ROSC group and 24% ± 15 in the no-ROSC group (p = .004; mean ± SD). Higher mean rSO values were observed in the ROSC group compared to the no-ROSC group (41% ± 13 versus 33% ± 13 respectively; p < 0.001). The median increase in rSO measured from start until two minutes before ROSC, was higher in the ROSC group (ROSC group 17% (IQR 6-29)) than in the no-ROSC group (8% (IQR 2-13); p < 0.001). An increase in rSO above 15% was associated with ROSC (OR 4.5; 95%CI 2.747-7.415; p < 0.001).
Regional cerebral saturation measurements can be used during pre-hospital ALS as an additional marker to predict ROSC. An increase of at least 15% in rSO during ALS is associated with a higher probability of ROSC.
迄今为止，在院前高级生命支持（ALS）期间的监测选择有限。区域性脑饱和度（rSO）可能在 ALS 期间提供有关大脑的更多信息。我们假设，院外心脏骤停（OHCA）患者在 ALS 期间 rSO 的增加与自主循环恢复（ROSC）有关。
在比利时的六家医院的院前环境中进行了一项前瞻性、非随机多中心研究。在 OHCA 患者的院前 ALS 期间，由医疗急救小组测量脑饱和度。脑饱和度在 ALS 期间持续测量，直到 ALS 努力结束或持续 ROSC（>20 分钟）的患者到达急诊室。为了考虑数据的纵向性质，使用了线性混合模型。通过随机截距和随机斜率来处理患者的重复测量之间的相关性。我们的主要分析测试了 rSO 与 ROSC 的相关性。
在 329 名患者中，有 110 名（33%）实现了 ROSC。在 ROSC 组中首次测量的 rSO 为 30%±18，在无 ROSC 组中为 24%±15（p=0.004；平均值±标准差）。与无 ROSC 组相比，ROSC 组的平均 rSO 值更高（分别为 41%±13 和 33%±13；p<0.001）。在 ROSC 开始前两分钟内从测量的 rSO 中位数增加，在 ROSC 组中更高（ROSC 组 17%（IQR 6-29）），而在无 ROSC 组中更低（8%（IQR 2-13）；p<0.001）。rSO 增加超过 15%与 ROSC 相关（OR 4.5；95%CI 2.747-7.415；p<0.001）。
在院前 ALS 期间可以使用区域性脑饱和度测量作为预测 ROSC 的附加标志物。ALS 期间 rSO 的增加至少 15%与 ROSC 的可能性更高相关。
