Cerebral saturation in cardiac arrest patients measured with near-infrared technology during pre-hospital advanced life support. Results from Copernicus I cohort study

Abstract

Aim: To date, monitoring options during pre-hospital advanced life support (ALS) are limited. Regional cerebral saturation (rSO(2)) may provide more information concerning the brain during ALS. We hypothesized that an increase in rSO(2) during ALS in out-of hospital cardiac arrest (OHCA) patients is associated with return of spontaneous circulation (ROSC). Methods: A prospective, non-randomized multicenter study was conducted in the pre-hospital setting of six hospitals in Belgium. Cerebral saturation was measured during pre-hospital ALS by a medical emergency team in OHCA patients. Cerebral saturation was continuously measured until ALS efforts were terminated or until the patient with sustained ROSC (> 20 min) arrived at the emergency department. To take the longitudinal nature of the data into account, a linear mixed model was used. The correlation between the repeated measures of a patient was handled by means of a random intercept and a random slope. Our primary analysis tested the association of rSO(2) with ROSC. Results: Of the 329 patients 110 (33%) achieved ROSC. First measured rSO(2) was 30% +/- 18 in the ROSC group and 24% +/- 15 in the no-ROSC group (p = .004; mean +/- SD). Higher mean rSO(2) values were observed in the ROSC group compared to the no-ROSC group (41% +/- 13 versus 33% +/- 13 respectively; p < 0.001). The median increase in rSO(2), measured from start until two minutes before ROSC, was higher in the ROSC group (ROSC group 17% (IQR 6-29)) than in the no-ROSC group (8% (IQR 2-13); p < 0.001). An increase in rSO(2) above 15% was associated with ROSC (OR 4.5; 95% CI 2.747-7.415; p < 0.001). Conclusion: Regional cerebral saturation measurements can be used during pre-hospital ALS as an additional marker to predict ROSC. An increase of at least 15% in rSO(2) during ALS is associated with a higher probability of ROSC.