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Difference in cerebral saturation during cardiopulmonary resuscitation between survivors with favorable neurological outcome and compromised neurological outcome at hospital discharge

Introduction

During out-of-hospital cardiac arrest (OHCA) monitoring possibilities are limited. Recently, the role of cerebral oximetry, using near-infrared spectroscopy, during ALS was investigated. In this study we determined whether the magnitude of increase in cerebral saturation (rSO2) or mean rSO2 during prehospital ALS was associated with good neurological outcome at hospital discharge (Cerebral Performance Category (CPC) 1 or 2).

Methods

With IRB approval, we prospectively measured rSO2 during ALS in consecutive OHCA patients. One sensor of the Equanox™ 7600 (NONIN) was applied on the patient's forehead's right side when the medical emergency team arrived in an OHCA. ROSC was defined as ROSC >20 minutes.

Results

We included 88 prehospital cardiac arrest patients between December 2011 and October 2014 with eight (9%) patients with CPC 1 or 2. Twenty-seven patients of the nonsurvivors had ROSC >20 minutes and one patient had CPC 3 at hospital discharge. We observed no significant difference between both groups in age (P = 0.161), time between emergency call and start of ALS (P = 0.788) and duration of basic life support performed by bystanders, general practitioners or paramedics (P = 0.649). The initial rhythm was asystole in one (12.5%) survivor and in 50 (62.5%) nonsurvivors (P = 0.009), ventricular fibrillation in six (75%) survivors and 13 (16%) nonsurvivors (P = 0.001), and pulseless electrical activity in one (12.5%) survivor and 17 (21%) nonsurvivors (P = 1.00). The cardiac arrest was witnessed in all survivors (100%) and in 49 (61%) nonsurvivors (P = 0.046). First measured rSO2 was 38% (27 to 67) in the survivor group compared with 22% (8 to 32) in the nonsurvivor group (P = 0.004). Also a significant difference was found in mean rSO2 until 1 minute before ROSC between survivors and nonsurvivors, respectively 46% (40 to 74) and 34% (22 to 42). We observed no significant difference in increase of rSO2 until 1 minute before ROSC between survivors 12.5% (5 to 21) and nonsurvivors 11% (5 to 18) (P = 0.719).

Conclusion

We observed a significant difference in first measured rSO2 and mean rSO2 until 1 minute before ROSC between patients with good neurological outcome (CPC 1 or 2) at hospital discharge and patients with worse neurological outcome or nonsurvivors (CPC 3 or 4 or 5). However, no significant difference was observed in the increase between both groups. Larger studies are necessary to confirm these results.

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Genbrugge, C., Boer, W., Meex, I. et al. Difference in cerebral saturation during cardiopulmonary resuscitation between survivors with favorable neurological outcome and compromised neurological outcome at hospital discharge. Crit Care 19, P429 (2015). https://doi.org/10.1186/cc14509

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Keywords

  • Cardiac Arrest
  • Hospital Discharge
  • Neurological Outcome
  • Cerebral Performance Category
  • Basic Life Support