The relationship between cerebral regional oxygen saturation during extracorporeal cardiopulmonary resuscitation and the neurological outcome in a retrospective analysis of 16 cases

Naoki Ehara; Tomoya Hirose; Tadahiko Shiozaki; Akinori Wakai; Tetsuro Nishimura; Nobuto Mori; Mitsuo Ohnishi; Daikai Sadamitsu; Takeshi Shimazu

doi:10.1186/s40560-017-0216-1

The relationship between cerebral regional oxygen saturation during extracorporeal cardiopulmonary resuscitation and the neurological outcome in a retrospective analysis of 16 cases

J Intensive Care. 2017 Feb 23:5:20. doi: 10.1186/s40560-017-0216-1. eCollection 2017.

Authors

Naoki Ehara¹, Tomoya Hirose², Tadahiko Shiozaki², Akinori Wakai¹, Tetsuro Nishimura¹, Nobuto Mori², Mitsuo Ohnishi², Daikai Sadamitsu¹, Takeshi Shimazu²

Affiliations

¹ Traumatology and Critical Care Medical Center, National Hospital Organization Osaka National Hospital, 2-1-14 Hoenzaka Chuo-ku, Osaka, Osaka 540-0006 Japan.
² Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita, Osaka 565-0871 Japan.

Abstract

Background: In recent years, the measurement of cerebral regional oxygen saturation (rSO₂) during resuscitation has attracted attention. The objective of this study was to clarify the relationship between the serial changes in the cerebral rSO₂ values during extracorporeal cardiopulmonary resuscitation (ECPR) and the neurological outcome.

Methods: We measured the serial changes in the cerebral rSO₂ values of patients with out-of-hospital cardiac arrest before and after ECPR in Osaka National Hospital.

Results: From January 2013 through March 2015, the serial changes in the cerebral rSO₂ values were evaluated in 16 patients. Their outcomes, as measured by the Glasgow Outcome Scale (GOS) score at discharge, included good recovery (GR) (n = 4), vegetative state (VS) (n = 2), and death (D) (n = 10). In the poor neurological group (VS and D: n = 12; age, 52.8 ± 4.0 years), the cerebral rSO₂ values showed a significant increase during ECPR (5 min before ECPR: 52.0 ± 1.8%; 2 min before ECPR: 56.1 ± 2.3%; 2 min after ECPR: 63.5 ± 2.2%; 5 min after ECPR: 66.4 ± 2.2%; 10 min after ECPR: 67.6 ± 2.3% [P < 0.01]). In contrast, in the good neurological group (GR: n = 4; age, 53.8 ± 6.9 years), the cerebral rSO₂ values did not increase to a significant extent during ECPR (5 min before ECPR: 61.9 ± 3.1%; 2 min before ECPR: 57.1 ± 4.0%; 2 min after ECPR: 59.6 ± 3.8%; 5 min after ECPR: 61.0 ± 3.7%; 10 min after ECPR: 62.0 ± 3.8% [P = 0.88]). Our study suggested that the patients whose cerebral rSO₂ values showed no significant improvement after ECPR might have had a good neurological prognosis.

Conclusions: The serial changes in the cerebral rSO₂ values during ECPR may predict a patient's neurological outcome. The further evaluation of the validity of rSO₂ monitoring during ECPR may lead to a new resuscitation strategy.

Keywords: Cerebral regional oxygen saturation; Extracorporeal cardiopulmonary resuscitation; Near-infrared spectroscopy; Neurological outcome; Out-of-hospital cardiac arrest.