Abstract
Background
Cerebral regional oxygen saturation (rSO2) can be measured immediately and noninvasively just after arrival at the hospital
and may be useful for evaluating the futility of resuscitation for a patient with
out-of-hospital cardiopulmonary arrest (OHCA). We examined the best practices involving
cerebral rSO2 as an indicator of the futility of resuscitation.
Methods
This study was a single-center, prospective, observational analysis of a cohort of
consecutive adult OHCA patients who were transported to the University of Tokyo Hospital
from October 1, 2012, to September 30, 2013, and whose cerebral rSO2 values were measured.
Results
During the study period, 69 adult OHCA patients were enrolled. Of the 54 patients
with initial lower cerebral rSO2 values of 26% or less, 47 patients failed to achieve return of spontaneous circulation
(ROSC) in the receiver operating characteristic curve analysis (optimal cutoff, 26%;
sensitivity, 88.7%; specificity, 56.3%; positive predictive value, 87.0%; negative
predictive value, 60.0%; area under the curve [AUC], 0.714; P = .0033). The AUC for the initial lower cerebral rSO2 value was greater than that for blood pH (AUC, 0.620; P = .1687) or lactate values (AUC, 0.627; P = .1081) measured upon arrival at the hospital as well as that for initial higher
(AUC, 0.650; P = .1788) or average (AUC, 0.677; P = .0235) cerebral rSO2 values. The adjusted odds ratio of the initial lower cerebral rSO2 values of 26% or less for ROSC was 0.11 (95% confidence interval, 0.01-0.63; P = .0129).
Conclusions
Initial lower cerebral rSO2 just after arrival at the hospital, as a static indicator, is associated with non-ROSC.
However, an initially lower cerebral rSO2 alone does not yield a diagnosis performance sufficient for evaluating the futility
of resuscitation.
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Article Info
Publication History
Published online: March 06, 2014
Accepted:
February 25,
2014
Received in revised form:
February 13,
2014
Received:
January 21,
2014
Footnotes
☆Contributors: T Fukuda, as the principal investigator, made substantial contributions to idea formation, study design and completion, data collection, management, and analysis, interpretation of results, and drafting and revising the manuscript. N Ohashi, M Nishida, M Gunshin, K Doi, T Matsubara, S Nakajima, and N Yahagi participated in idea formation, data collection and management, and reviewing the manuscript critically for important intellectual content. T Fukuda performed the statistical analysis. All authors approved the final version for publication.
☆☆Funding sources: This study was supported in part by a grant from the University of Tokyo Hospital.
★Conflict of interest statement: We declare that we have no conflicts of interest.
Identification
Copyright
© 2014 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
