Usefulness of cerebral rSO monitoring during CPR to predict the probability of return of spontaneous circulation.

BACKGROUND

Cerebral oximetry (rSO) may be useful in assessing the probability of return of spontaneous circulation (ROSC). However, the potential of assessing the trend in the rSO value has not been discussed when determining the probability of ROSC.

METHODS

This was a retrospective study of out-of-hospital cardiac arrest (OHCA) patients with continuous rSO values recorded during cardiopulmonary arrest. We used logistic regression analysis at each time point to investigate the best subsets of rSO-related variables for ROSC, which included rSO (baseline), the baseline value of rSO; amount of maximum rise, the maximum difference of rSO from rSO (baseline) over t minutes; ΔrSO (t):(amount of maximum rise)/rSO (baseline) over t minutes after hospital arrival.

RESULTS

Among the 90 included patients, 35 achieved ROSC. Area under the curve (AUC) analysis revealed that ΔrSO over a 16-min measurement period was significantly higher than ΔrSO measured over 4-, 8-, 12-, and 20-min periods. During this 16-min period, the subset showing the best AUC value was interaction of the amount of maximum rise and rSO (baseline) rather than the amount of maximum rise or ΔrSO alone (AUC = 0.91).

CONCLUSIONS

The combination of rSO (baseline) with the amount of maximum rise in rSO value over time might be a new index for the prediction of ROSC that could be useful in guiding cardiopulmonary resuscitation. Further studies are needed to validate these findings.