Eskisehir Osmangazi University, Faculty of Medicine, Department of Emergency Medicine, Buyukdere Mah, Prof. Dr. Nabi AVCI Bulvarı No: 4, 26040 Odunpazarı, Eskisehir, Turkey.
Eskisehir Osmangazi University, Faculty of Medicine, Department of Emergency Medicine, Buyukdere Mah, Prof. Dr. Nabi AVCI Bulvarı No: 4, 26040 Odunpazarı, Eskisehir, Turkey.
Am J Emerg Med. 2021 Mar;41:163-169. doi: 10.1016/j.ajem.2020.06.031. Epub 2020 Jun 28.
We aimed to compare regional cerebral oxygen saturation (rSO) levels during cardiopulmonary resuscitation (CPR), performed either manually or using a mechanical chest compression device (MCCD), in witnessed cardiac arrest cases in the emergency department (ED), and to evaluate the effects of both the CPR methods and perfusion levels on patient survival and neurological outcomes.
This single-center, randomized study recruited patients aged ≥18 years who had witnessed a cardiopulmonary arrest in the ED. According to the relevant guidelines, CPR was performed either manually or using an MCCD. Simultaneously, rSO levels were continually measured with near-infrared spectroscopy.
Seventy-five cases were randomly distributed between the MCCD (n = 40) and manual CPR (n = 35) groups. No significant difference in mean rSO levels was found between the MCCD and manual CPR groups (46.35 ± 14.04 and 46.60 ± 12.09, respectively; p = 0.541). However, a significant difference in rSO levels was found between patients without return of spontaneous circulation (ROSC) and those with ROSC (40.35 ± 10.05 and 50.50 ± 13.44, respectively; p < 0.001). In predicting ROSC, rSO levels ≥24% provided 100% sensitivity (95% confidence interval [CI] 92-100), and rSO levels ≥64% provided 100% specificity (95% CI 88-100). The area under the curve for ROSC prediction using rSO levels during CPR was 0.74 (95% CI 0.62-0.83).
A relationship between ROSC and high rSO levels in witnessed cardiac arrests exists. Monitoring rSO levels during CPR would be useful in CPR management and ROSC prediction. During CPR, MCCD or manual chest compression has no distinct effect on oxygen delivery to the brain.
clinicaltrials.gov identifier: NCT03238287.
本研究旨在比较在急诊科目击心搏骤停患者中，行心肺复苏（CPR）时手动与使用机械胸外按压设备（MCCD）两种方法的区域性脑氧饱和度（rSO）水平，并评估两种 CPR 方法和灌注水平对患者生存和神经结局的影响。
这是一项单中心、随机研究，纳入了在急诊科目击心搏骤停的年龄≥18 岁的患者。根据相关指南，对患者行手动或 MCCD 心肺复苏。同时，使用近红外光谱仪持续测量 rSO 水平。
75 例患者被随机分为 MCCD（n=40）和手动 CPR（n=35）组。MCCD 组与手动 CPR 组的平均 rSO 水平无显著差异（分别为 46.35±14.04 和 46.60±12.09；p=0.541）。但未出现自主循环恢复（ROSC）和出现 ROSC 的患者之间的 rSO 水平存在显著差异（分别为 40.35±10.05 和 50.50±13.44；p<0.001）。rSO 水平预测 ROSC 的界值为≥24%时灵敏度为 100%（95%置信区间[CI]92%-100%），rSO 水平≥64%时特异性为 100%（95% CI 88%-100%）。CPR 期间 rSO 水平预测 ROSC 的曲线下面积为 0.74（95% CI 0.62-0.83）。
目击心搏骤停患者的 ROSC 与高 rSO 水平之间存在关联。CPR 期间监测 rSO 水平有助于 CPR 管理和 ROSC 预测。CPR 期间，MCCD 或手动胸外按压对脑氧输送无明显影响。
clinicaltrials.gov 标识符：NCT03238287。
