Abstract 2231: The Prognostic Value of Cerebral Oximetry for Early Prediction of Neurologic Outcome After OOHCA.
No reliable early predictors of neurological outcome exist for patients resuscitated from an OOHCA.
Objectives: We investigated the prognostic utility of early cerebral oximetry (rSO2) on neurological outcome after resuscitation from OOHCA.
Methods: We prospectively conducted an observational trial on a convenience sample of patients admitted with a pulse after OOHCA. rSO2 sensors were placed on patient’s forehead on arrival and left in place at least until discharge from the ED. We recorded demographics and data in accordance with the Utstein criteria. Investigators unaware of early rSO2 values recorded CPC scores on all patients. rSO2 data was dichotomized as being normal (>45% and <80%) or abnormal (ABN), with the initial and final ED rSO2 evaluated. Outcome measure was a good CPC (≤2) at hospital discharge and 30 day follow-up. We present descriptive statistics with L.R. and O.R.
Results: We have currently enrolled 64 patients: 56% were male, mean of 69 yo, (16 to 93), 75% were witnessed, 31% in a public place and 44% had bystander CPR. The initial rhythm was VF in 53%, PEA in 17% and asystole in 30%. Overall good CPC occurred in 19 (30%) of patients. Of all recorded data initial rhythm and rSO2 were the best predictors of outcome. Comparing final rSO2 to initial VF rhythm SENS, 0.98 (0.89–0.99) v 0.89 (0.86–0.94), SPEC, 0.38 (0.30–0.46) v 0.62 (0.28–0.74), LR+1.57 v 1.62, LR−, 0.06-v 0.07, respectively. The OR for predicting CPC were 23.9 for final rSO2 and 19.8 for VF, of note in VF patients rSO2 had an OR of 19.8 for predicting CPC.
Conclusion: Abnormal cerebral oximetry at ED discharge was an excellent predictor of poor neurological outcome. Cerebral oximetry appears to have better sensitivity and OR for predicting final CPC than VF rhythm. This study is limited by its observational nature and by the non-uniform use of therapeutic hypothermia.