Schnaubelt Sebastian, Kornfehl Andrea, Eibensteiner Felix, Schriefl Christoph, Mayr Florian B, Aigner Patrick, Gatterbauer Mathias, Girsa Michael, Grassmann Daniel, Zajicek Andreas, Spiel Alexander, Schreiber Wolfgang, Holzer Michael, Losert Heidrun, Krammel Mario, Uray Thomas
Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria.
PULS - Austrian Cardiac Arrest Awareness Association, Vienna, Austria.
Front Med (Lausanne). 2025 Aug 15;12:1590908. doi: 10.3389/fmed.2025.1590908. eCollection 2025.
An increase in regional cerebral oxygen saturation (rSO2) levels during advanced life support in patients with out-of-hospital cardiac arrest (OHCA) is associated with return of spontaneous circulation (ROSC) and can predict neurological outcome. Data from the post-ROSC phase are scarce but may predict clinical outcomes as well.
For this prospective observational study, we measured rSO2 via near-infrared spectroscopy (NIRS) in patients after ROSC following OHCA in both the pre- and in-hospital setting for up to 72 h. Patients were followed up for their post-ROSC treatment and outcomes. NIRS values were then compared between patients with favorable and non-favorable neurological outcomes, and cutoff values were assessed via receiver operating characteristic (ROC) and Classification and Regression Trees (CART) analyses. In addition, a narrative review on the topic was performed.
Of the 27 included patients, 37% survived hospital discharge, and 26% showed favorable neurological outcomes (CPC 1 or 2). RSO2 was significantly higher in individuals with CPC 1/2 (67 [60-69] % vs. 59 [50-70] %; = 0.049). This was even more pronounced for initial (= a mean of the first 5 min) NIRS values (70 [65-77] % vs. 57 [49-68] %; = 0.025) and NIRS values rising in the first 10 min (43% vs. 5% of patients; = 0.042). A ROC analysis for initial rSO2 showed a significant discriminatory power to predict CPC 1/2 (AUC = 0.789, = 0.025), and both ROC and CART analyses suggested an optimal cutoff of approximately 62% rSO2.
We identified a potential RSO2 cutoff measured via NIRS in the post-ROSC phase after OHCA to predict favorable neurological outcomes. Initial values and rising trends may be more useful for prognostication than prolonged ICU measurements. These findings are consistent with previous literature and should prompt both larger clinical trials and consideration of this technology by resuscitation societies.
院外心脏骤停（OHCA）患者在高级生命支持期间区域脑氧饱和度（rSO2）水平的升高与自主循环恢复（ROSC）相关，并且可以预测神经功能结局。ROSC后阶段的数据很少，但也可能预测临床结局。
在这项前瞻性观察性研究中，我们通过近红外光谱（NIRS）测量了OHCA后ROSC患者在院前和院内环境中长达72小时的rSO2。对患者进行ROSC后治疗及结局的随访。然后比较神经功能结局良好和不良的患者之间的NIRS值，并通过受试者工作特征（ROC）和分类回归树（CART）分析评估临界值。此外，对该主题进行了叙述性综述。
在纳入的27例患者中，37%存活出院，26%显示神经功能结局良好（脑功能分类CPC为1或2）。CPC 1/2的个体rSO2显著更高（67[60 - 69]%对59[50 - 70]%；P = 0.049）。对于初始（即前5分钟的平均值）NIRS值（70[65 - 77]%对57[49 - 68]%；P = 0.025）和前10分钟内上升的NIRS值（患者比例分别为43%对5%；P = 0.042），这种差异更为明显。对初始rSO2的ROC分析显示对预测CPC 1/2具有显著的判别能力（曲线下面积AUC = 0.789，P = 0.025），并且ROC和CART分析均表明rSO2的最佳临界值约为62%。
我们确定了OHCA后ROSC阶段通过NIRS测量的rSO2潜在临界值，以预测良好的神经功能结局。初始值和上升趋势可能比在重症监护病房（ICU）的长期测量对预后更有用。这些发现与先前的文献一致，应促使开展更大规模的临床试验，并促使复苏协会考虑这项技术。
