Abstract 48: A Multicenter Prospective Cohort Study on a Novel Neurological Prognostic Index, Regional Brain Oxygen Saturation, in Patients with Out-of-Hospital Cardiac Arrest
BACKGROUNDS: A reliable and readily available neurological prognostic index for the cerebral resuscitation of out-of-hospital cardiac arrest (OHCA) patients (pts) is required. We have previously reported in a single center cohort study of OHCA pts that regional brain oxygen saturation (rSO2) measured on hospital arrival may help predict neurological outcomes.
OBJECTIVE: To compare the power of rSO2 and conventional indexes−lactate, base excess (BE), and ammonia (NH3)−measured on hospital arrival to prognose neurological outcomes at 30 days after cardiac arrest that are assessed according to the cerebral performance category (CPC) criteria in a multicenter prospective cohort study.
METHODS: The database of the J-POP registry (conducted at 14 tertiary emergency hospitals in Japan) has prospectively enrolled 764 OHCA pts. Of these pts, 596 (77.5%) who were examined for rSO2, lactate, BE, and NH3 were analyzed in the present study. The exclusion criteria included 1) trauma, 2) accidental hypothermia, 3) age under 18, 4) do not attempt resuscitation order, 5) Glasgow Coma Scale > 8 on hospital arrival, and 6) missing data. Immediately after hospital arrival, rSO2 was measured using a near-infrared spectroscopy device (INVOS; Covidien, USA) placed on the forehead, along with the measurement of lactate, BE, and NH3. Regardless of the rSO2 readings, all pts received the best available therapy.
RESULTS: Among 596 OHCA pts, 31 (5.2%) had good neurological outcome. The areas under the curve (AUCs) for the prognostic indexes-rSO2, lactate, BE, and NH3−were 0.912, 0.794, 0.773 and 0.853, respectively (Table). The AUC was significantly greater for rSO2 than for lactate (p = 0.0001) or BE (p = 0.0057) and tended to be greater for NH3 (p = 0.0844).
CONCLUSIONS: Compared with the conventional neurological prognostic indexes, rSO2 may be more reliable for neurological prognostication based on its specificity, positive predictive value, and AUC.
- © 2012 by American Heart Association, Inc.