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Differences in cerebral saturation measured during prehospital advanced life support, between patients with presumed cardiac origin and noncardiac origin of cardiac arrest

Introduction

During out-of hospital cardiac arrest (OHCA) cerebral saturation may provide relevant information on cerebral oxygenation. In this study we examined the time course in cerebral saturation (rSO2) during prehospital ALS comparing patients with a presumed cardiac origin (survivor = Sc, nonsurvivor = NSc) of arrest and noncardiac origin (survivor = Snc, nonsurvivor = NSnc) of arrest.

Methods

With IRB approval, we prospectively measured rSO2 from the start of ALS in consecutive OHCA patients. One sensor (Equanox™ 7600; Nonin) was applied on the patient's forehead's right side when the medical emergency team arrived at the OHCA setting. ROSC was defined as ROSC >20 minutes. Retrospectively, included patients were divided into two groups with respect to their presumed origin of arrest.

Results

Between December 2011 and October 2014, 113 OHCA patients were included. We observed a significant difference in asystole and VF as initial rhythm between NSc and NSnc, respectively (P = 0.035 and P = 0.001). In both groups of NS, duration of ALS was significant longer compared with the two S groups (P = 0.001 in both comparisons). We observed no significant difference in first measured rSO2, mean rSO2 until 1 minute before ROSC and increase in rSO2 until 1 minute before ROSC (respectively P = 0.123, P = 0.501, P = 0.265) between Sc and Snc. However, when we compare the nonsurvivors of cardiac with noncardiac origin, we observed a significant difference in mean rSO2 until 1 minute before ROSC, 35% (27 to 44) in the NSc group and 27 (21 to 34) in the NSnc group (P = 0.026). First measured rSO2 was 24.5% (13 to 34) in the NSc group and 14 (4 to 28) in the NSnc group (P = 0.069) trending to be significantly different. No significant difference was observed in increase until 1 minute before ROSC between both groups of NS (P = 0.920). Significant differences was observed in mean rSO2 until 1 minute before ROSC and increase in rSO2 between Snc and NSnc (P = 0.033; P < 0.001) and between Sc and NSc (P = 0.001; P < 0.001).

Conclusion

We can conclude that NSc have a significant higher mean rSO2 and trend to have a significant difference in first measured rSO2 compared with NSnc. However, no significant difference was observed between Sc and Snc.

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Genbrugge, C., Boer, W., Anseeuw, K. et al. Differences in cerebral saturation measured during prehospital advanced life support, between patients with presumed cardiac origin and noncardiac origin of cardiac arrest. Crit Care 19, P435 (2015). https://doi.org/10.1186/cc14515

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Keywords

  • Relevant Information
  • Life Support
  • Nonin
  • Medical Emergency
  • Cerebral Oxygenation