부산대학교 도서관

Background: Very few prognosis markers are available to help emergency medical services decide whether to continue or terminate cardiopulmonary resuscitation (CPR). ETCO2 has been described to predict return of spontaneous circulation (ROSC) but its ability to predict neurologic outcome is poor. Cerebral tissue oxygen saturation (RSO2) during CPR, as measured by near-infrared spectroscopy (NIRS) represents hemoglobin oxygenation within the cerebral tissue. The measure is feasible during CPR. It has been associated with the probability of ROSC. The aim of this study was to assess the predictive value of RSO2 regarding 30 days favorable neurologic outcome after out-of-hospital cardiac arrest (OHCA).Method: Data were collected during a prospective single center before-after interventional study comparing conventional CPR (C-CPR) with Automated head and thorax elevation CPR (AHUP). C-CPR was performed manually and AHUP-CPR was delivered using a LUCAS Active Decompression (Stryker Medical, USA), an EleGARD Patient Positioning System (AdvancedCPR Solutions, USA), and an impedance threshold device (ResQPOD-16, Zoll, USA). The study was carried out in four fire stations and one physician staffed advanced life support emergency medical services in France. ETCO2 (using an EMMA, Massimo or Lifepack 15, Stryker, USA) and RSO2 (H500, Nonin, USA) were collected as soon as possible during CPR. Favorable neurologic outcome was defined as MRS score of 0 to 3 at 30 days. Results are presented as mean ± standard deviation.Results: ETCO2 was collected in 118 patients (11 with good neurologic outcome) and RSO2 in 69 patients (6 with good neurologic outcome). Maximum ETCO2 during CPR was 43±19mmHg in favorable neurologic outcome patients vs. 35±16mmHg (p=0.13). ETCO2 alone had an AUC of 0,63 (IC95% 0.46-0.79). Maximum RSO2 during CPR was 68±13% for favorable neurologic outcome patients vs. 49±13% (p<0.001). For survival with favorable neurologic outcome, rSO2 alone had an AUC of 0.85 (IC95% 0.71-0.99). With a maximum RSO2 value below 51% there was no patient with favorable neurologic outcome.Conclusion: In this prospective interventional study, unlike EtCO2, RSO2 values were significantly associated with favorable neurological survival at 30 days.