Abstract 227: Severity Assessment of Brain Damage with rSO2 Monitoring for Decisions Regarding Intensive Care After Out-of-Hospital Cardiac Arrest with Presumed Cardiac Causes
Background: It is difficult to assess the severity of brain damage during prognostication in patients immediately after out-of-hospital cardiac arrest (OHCA). Thus, decisions regarding intensive care, including target temperature management (TTM) and coronary angiography (CAG), for these patients are difficult to make.
Methods: The J-POP registry is a prospective multicenter cohort study to test whether regional brain oxygen saturation (rSO2) predicts neurological outcomes after nontraumatic OHCA. We measured rSO2 values in OHCA patients immediately after hospital arrival with a near-infrared spectrometer placed on the forehead. The primary endpoint was neurological outcome (cerebral performance category: 1, 2) 90 days after OHCA.
Results: We consecutively enrolled 1,095 OHCA patients with presumed cardiac causes, including 89 comatose patients with return to spontaneous circulation (ROSC) at hospital arrival (7%) and 1,106 cardiac arrest patients at hospital arrival (93%). After 90 days, 68 patients (6%) had good neurological outcomes. The median rSO2 value was 15% (range: 15% - 20%), and a receiver operating curve analysis indicated an optimal rSO2 cutoff of > 40% for good neurological outcome (area under the curve: 0.922). Good neurological outcome occurred in 13/1,092 (1%) with rSO2 values ≤ 40% and 55 / 103 (53%) with rSO2 values > 40%. Even without ROSC at hospital arrival, 30% (9 / 30) had good neurological outcomes. Nevertheless, all 16 patients with low rSO2 values (≤ 40%) had poor neurological outcomes even if they had ROSC at hospital arrival (see figure). Furthermore, in many cases with high rSO2 values (> 40%) TTM (34%, 35 / 103) and CAG (45%, 46 / 103) were not performed.
Conclusion: Regardless of ROSC at hospital arrival, rSO2 value monitoring in the emergency room was useful for speculating on brain damage severity for decisions regarding intensive care. However, in many cases with high rSO2 values, TTM and CAG were not performed actually.
- Cerebrovascular circulation
- Post cardiac arrest care
- Emergency medical services (EMS)
Author Disclosures: K. Nishiyama: Research Grant; Significant; Grant-in-Aid for Scientific Research (KAKENHI) from the Ministry of Education, Culture, Sports, Science and Technology (MEXT) of Japan. N. Ito: Research Grant; Significant; Grant-in-Aid for Scientific Research (KAKENHI) from the Ministry of Education, Culture, Sports, Science and Technology (MEXT) of Japan. M. Abe: None. T. Unoki: None. T. Endo: None. H. Himeno: None. N. Yamada: None. M. Mizobuchi: None. T. Mochizuki: None. K. Kikuchi: None. K. Hayashida: None. H. Arimoto: None. T. Orita: None. K. Nagao: None.
- © 2014 by American Heart Association, Inc.