Shin Jenny, King Julia, Walker Robert, Yost Dana, Blackwood Jennifer, Coult Jason, Chapman Fred, Neumar Robert W, Kudenchuk Peter, Rea Thomas
Emergency Medical Services Division of Public Health - Seattle & King County, United States.
University of Washington, Department of Medicine, United States.
Resuscitation. 2025 Aug 7;215:110761. doi: 10.1016/j.resuscitation.2025.110761.
Anoxic brain injury is a common mode of death following out-of-hospital cardiac arrest (OHCA). We assessed the course of regional cerebral oxygen saturation (rSO) during resuscitation to understand its association with return of spontaneous circulation (ROSC) and functional survival.
We conducted a prospective observational investigation of OHCA patients treated by Emergency Medical Services (EMS) in a suburban community. Real-time rSO was characterized overall and according to ROSC and favorable survival defined by Cerebral Performance Category (CPC) 1-2. We also calculated ΔrSO, defined as the change in rSO from pre- to post-ROSC among those who achieved ROSC, and compared to a time-matched rSO difference among those receiving CPR who did not achieve ROSC.
Of 140 eligible cases, 93 were enrolled. Of these, 55 % (n = 51) achieved ROSC and 10 % (n = 9) survived with CPC 1-2. Upon cerebral oximeter application, the median rSO was 33 % (interquartile range = 22.45 %). Initial rSO did not predict subsequent ROSC (38 % ROSC vs 27 % no ROSC, AUC = 0.61, p = 0.13) or subsequent favorable survival (45 % CPC 1-2 vs 32 % no survival with CPC 1-2, AUC = 0.77, p = 0.17). However, real-time rSO and ΔrSO were greater upon ROSC versus time-matched ongoing pulselessness (rSO = 60 % vs. 33 %, AUC = 0.84, p < 0.001; ΔrSO = 11 % vs. 1 %, AUC = 0.85, p < 0.001). Among those who achieved ROSC, rSO and ΔrSO during the peri-ROSC period was greater among those with subsequent favorable survival (rSO = 63 % vs. 46 %, AUC = 0.74, p = 0.06; ΔrSO = 29 % vs. 10 %, AUC = 0.77, p = 0.04) CONCLUSION: Greater values of rSO and ΔrSO identified instantaneous ROSC and predicted favorable neurological survival among those who achieved ROSC.
缺氧性脑损伤是院外心脏骤停（OHCA）后常见的死亡方式。我们评估了复苏过程中局部脑氧饱和度（rSO）的变化过程，以了解其与自主循环恢复（ROSC）及功能存活的关系。
我们对一个郊区社区接受紧急医疗服务（EMS）治疗的OHCA患者进行了一项前瞻性观察研究。总体上以及根据ROSC和脑功能分类（CPC）1 - 2定义的良好存活情况对实时rSO进行了特征分析。我们还计算了ΔrSO，定义为实现ROSC的患者从ROSC前到ROSC后的rSO变化，并与未实现ROSC的接受心肺复苏患者在时间匹配的rSO差异进行比较。
140例符合条件的病例中，93例被纳入研究。其中，55%（n = 51）实现了ROSC，10%（n = 9）存活且CPC为1 - 2。应用脑血氧饱和度仪时，rSO中位数为33%（四分位间距 = 22.45%）。初始rSO不能预测随后的ROSC（实现ROSC者为38%，未实现ROSC者为27%，AUC = 0.61，p = 0.13）或随后的良好存活情况（CPC 1 - 2存活者为45%，CPC 1 - 2未存活者为32%，AUC = 0.77，p = 0.17）。然而，与时间匹配的持续无脉状态相比，ROSC时的实时rSO和ΔrSO更高（rSO = 60%对33%，AUC = 0.84，p < 0.001；ΔrSO = 11%对1%，AUC = 0.85，p < 0.001）。在实现ROSC的患者中，随后有良好存活者在ROSC周围时期的rSO和ΔrSO更高（rSO = 63%对46%，AUC = 0.74，p = 0.06；ΔrSO = 29%对10%，AUC = 0.77，p = 0.04）。结论：rSO和ΔrSO值更高可识别即时ROSC，并预测实现ROSC者的良好神经功能存活情况。
