Department of Emergency and Critical Care Medicine, Yamagata University Hospital, 2-2-2, Iida-nishi, Yamagata, Yamagata, 990-9585, Japan.
Department of Anesthesiology, Yamagata University Hospital, 2-2-2, Iida-nishi, Yamagata, Yamagata, 990-9585, Japan.
BMC Emerg Med. 2022 Feb 28;22(1):30. doi: 10.1186/s12873-022-00586-9.
It is difficult to predict the return of spontaneous circulation (ROSC) during cardiopulmonary resuscitation (CPR). Cerebral tissue oxygen saturation during CPR, as measured by near-infrared spectroscopy (NIRS), is anticipated to predict ROSC. General markers of cerebral tissue oxygen saturation, such as the tissue oxygenation index (TOI), mainly reflect venous oxygenation, whereas pulse-wave cerebral tissue oxygen saturation (SnO), which represents hemoglobin oxygenation in the pulse wave within the cerebral tissue, is an index of arterial and venous oxygenation. Thus, SnO may reflect arterial oxygenation to a greater degree than does TOI. Therefore, we conducted this study to verify our hypothesis that SnO measured during CPR can predict ROSC.
Cardiac arrest patients who presented at the Emergency Department of Yamagata University Hospital in Japan were included in this retrospective, observational study. SnO and TOI were simultaneously measured at the patient's forehead using an NIRS tissue oxygenation monitor (NIRO 200-NX; Hamamatsu Photonics, Japan). We recorded the initial, mean, and maximum values during CPR. We plotted receiver operating characteristic curves and calculated the area under the curve (AUC) to predict ROSC.
Forty-two patients were included. SnO was significantly greater in the ROSC group than in the non-ROSC group in terms of the initial (37.5% vs 24.2%, p = 0.015), mean (44.6% vs 10.8%, p < 0.001), and maximum (79.7% vs 58.4%, p < 0.001) values. Although the initial TOI was not significantly different between the two groups, the mean (45.1% vs 36.8%, p = 0.018) and maximum (71.0% vs 46.3%, p = 0.001) TOIs were greater in the ROSC group than in the non-ROSC group. The AUC was 0.822 for the mean SnO (95% confidence interval [CI]: 0.672-0.973; cut-off: 41.8%), 0.821 for the maximum SnO (95% CI: 0.682-0.960; cut-off: 70.8%), and 0.809 for the maximum TOI (95% CI: 0.667-0.951; cut-off: 49.3%).
SnO values measured during CPR, including immediately after arrival at the emergency department, were higher in the ROSC group than in the non-ROSC group.
心肺复苏（CPR）期间自主循环恢复（ROSC）难以预测。CPR 期间通过近红外光谱（NIRS）测量的脑组织氧饱和度预计可以预测 ROSC。一般的脑组织氧饱和度标志物，如组织氧指数（TOI），主要反映静脉氧合，而代表脉搏波内脑组织中血红蛋白氧合的脉搏波脑组织氧饱和度（SnO）是动脉和静脉氧合的指标。因此，SnO 可能比 TOI 更能反映动脉氧合程度。因此，我们进行了这项研究，以验证我们的假设，即在 CPR 期间测量的 SnO 可以预测 ROSC。
本回顾性观察研究纳入了在日本山形大学医院急诊科就诊的心脏骤停患者。使用近红外光谱组织氧合监测仪（NIRO 200-NX；滨松光子学，日本）同时测量患者前额的 SnO 和 TOI。我们记录了 CPR 期间的初始值、平均值和最大值。我们绘制了受试者工作特征曲线并计算了曲线下面积（AUC）以预测 ROSC。
共纳入 42 例患者。与非 ROSC 组相比，ROSC 组的初始（37.5%比 24.2%，p=0.015）、平均（44.6%比 10.8%，p<0.001）和最大（79.7%比 58.4%，p<0.001）SnO 值更高。虽然两组间初始 TOI 无显著差异，但 ROSC 组的平均（45.1%比 36.8%，p=0.018）和最大（71.0%比 46.3%，p=0.001）TOI 值更高。平均 SnO 的 AUC 为 0.822（95%置信区间[CI]：0.672-0.973；截断值：41.8%），最大 SnO 的 AUC 为 0.821（95%CI：0.682-0.960；截断值：70.8%），最大 TOI 的 AUC 为 0.809（95%CI：0.667-0.951；截断值：49.3%）。
在 ROSC 组中，CPR 期间（包括到达急诊科后立即）测量的 SnO 值高于非 ROSC 组。
