Abstract 241: Which Cerebral Saturation Should We Target in Post--Cardiac Arrest Patients?
Purpose: Current guidelines recommend targeting mean arterial pressure above 65mmHg and SVO2 above 70% in post-cardiac arrest patients. Blood pressure and SVO2 are only surrogate parameters for cerebral perfusion. Alternatively, cerebral saturation can be assessed directly and non-invasively with near infrared spectroscopy (NIRS), using the FORE-SIGHTTM technology (CAS Medical systems, Branford, CT, USA). It is unclear which cerebral saturation we should target to maximize patient survival. The aim of the present study was to explore the association between SctO2 and survival in post-cardiac arrest patients.
Methods: Prospective observational study in 82 post-cardiac arrest patients treated with therapeutic hypothermia. Cerebral saturation was measured every 2 seconds.
Results: During the first 24 hours after ICU admission, the average SctO2 was 65.5±4.5%. For each patient, the percentage of time was calculated per percentage cerebral saturation. Patients were stratified according to no (<2%), low (2-12.5%), intermediate (12.5-25%) or high exposure (>25% of time) per 3 percentage cerebral saturation. Logistic regression revealed a maximal association between cumulative SctO2 exposure and survival for the SctO2 range between 66-68% (OR 1.58, 95%CI [1.00; 1.51], p=0.04]. Multivariate regression revealed that administration of early bystander CPR, presenting shockable rhythm and high cumulative SctO2 exposure between 66-68% (OR 1.73, 95%CI [1.00; 3.01] were significant independent predictors of survival. ANOVA revealed that the percentage of early bystander CPR, presenting shockable rhythm, global hemodynamics (MAP, SVO2) and blood gasses (including pO2, pCO2) were comparable between patients with no, low, intermediate or high exposure to SctO2 66-68%.
Conclusion: The target SctO2 seems to be between 66-68%. Prospective intervention studies to reach or maintain this SctO2 target are needed to confirm these findings.
Author Disclosures: K. Ameloot: None. C. De Deyne: None. I. Meex: None. J. Haesen: None. C. Genbrugge: None. W. Mullens: None. F. Jans: None. M. Dupont: None. J. Dens: None.
- © 2014 by American Heart Association, Inc.