Pre-hospital portable monitoring of cerebral regional oxygen saturation (rSO2) by ambulance personnel during cardiopulmonary resuscitation: A prospective observational analysis of 87 cases in Osaka city, Japan

Tomohiko Sakai; Tomoya Hirose; Tadahiko Shiozaki; Ryosuke Takagawa; Mitsuo Ohnishi; Sumito Hayashida; Shinji Shigematsu; Keiichi Satou; Yasunori Takemoto; Takeshi Shimazu

doi:10.1016/j.resplu.2021.100093

Pre-hospital portable monitoring of cerebral regional oxygen saturation (rSO₂) by ambulance personnel during cardiopulmonary resuscitation: A prospective observational analysis of 87 cases in Osaka city, Japan

Resusc Plus. 2021 Mar 2:6:100093. doi: 10.1016/j.resplu.2021.100093. eCollection 2021 Jun.

Affiliations

¹ Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita, Osaka 565-0871, Japan.
² Traumatology and Critical Care Medical Center, National Hospital Organization Osaka National Hospital, 2-1-14 Hoenzaka, Chuo-Ku, Osaka-city, Osaka 540-0006, Japan.
³ Osaka Municipal Fire Department, 1-12-54 Kujo-Minami, Nishi-Ku, Osaka-city, Osaka 550-8566, Japan.

Abstract

Background: Regional cerebral oxygen saturation (rSO₂) is a non-invasive method of measuring cerebral perfusion; However, serial changes in cerebral rSO₂ values among out-of-hospital cardiac arrest (OHCA) patients in pre-hospital settings have not been sufficiently investigated. We aimed to investigate the association between the serial change in rSO₂ pattern and patient outcome.

Methods: We evaluated rSO₂ in OHCA patients using portable monitoring by emergency life-saving technicians (ELTs) from June 2013 to December 2019 in Osaka City, Japan. We divided the patterns of serial of rSO₂ change into type 1 (increasing pattern) and type 2 (non-increasing pattern). Patients in whom measurement started after return of spontaneous circulation (ROSC) were excluded. The outcome measures were 'Prehospital ROSC', 'Alive at admission', '1-month survival' and 'Cerebral Performance Category (CPC) 1 or 2'.

Results: Eighty-seven patients were eligible for this analysis (type 1: n = 40, median age: 80.5 [IQR: 72-85.5] years, male: n = 20 [50.0%]; type 2: n = 47, 81 [72-85.5] years, male: n = 28 [59.6%]). In a multivariable logistic regression adjusted for confounding factors, outcomes of 'Prehospital ROSC' and 'Alive at admission' were significantly higher in type 1 than type 2 pattern (11/40 [27.5%] vs. 2/47 [4.26%], AOR 5.67, 95% CI 1.04-30.96, p < 0.045 and 17/40 [42.5%] vs. 6/41 [12.8%], AOR 3.56, 95% CI 1.11-11.43, p < 0.033). There was no significant difference in '1-month survival' and 'CPC 1 or 2' between patterns.

Conclusion: Type 1 (increasing pattern) was associated with 'Prehospital ROSC' and 'Alive at admission'. Pre-hospital monitoring of cerebral rSO₂ might lead to a new resuscitation strategy.

Keywords: Emergency life-saving technician; Emergency medical services; Emergency medical technician; Near-infrared spectroscopy; Out-of-hospital cardiac arrest; Portable rSO2 monitor.