Noninvasive regional cerebral oxygen saturation for neurological prognostication of patients with out-of-hospital cardiac arrest: A prospective multicenter observational study

RESUSCITATION

卷:85

Article

Ito, Noritoshi^1,2  Nishiyama, Kei³  Callaway, Clifton W.⁴  Orita, Tomohiko⁵  Hayashida, Kei⁶  Arimoto, Hideki^7,8  Abe, Mitsuru⁹  Endo, Tomoyuki¹⁰  Murai, Akira¹¹  Ishikura, Ken¹²  Yamada, Noriaki¹³  Mizobuchi, Masahiro¹⁴  Anan, Hideki¹⁵  Okuchi, Kazuo¹⁶  Yasuda, Hideto¹⁷  Mochizuki, Toshiaki¹⁸  Tsujimura, Yuka¹⁹  Nakayama, Takeo¹⁹  Hatanaka, Tetsuo²⁰  Nagao, Ken²¹ 

[1] Osaka Saiseikai Senri Hosp, Senri Cardiovasc Ctr, Suita, Osaka 5650862, Japan

[2] Osaka Univ, Grad Sch Med, Dept Cardiovasc Med, Suita, Osaka 5650871, Japan

[3] Kyoto Univ, Dept Primary Care & Emergency Med, Grad Sch Med, Sakyo Ku, Kyoto 6068507, Japan

[4] Univ Pittsburgh, Dept Emergency Med, Pittsburgh, PA 15261 USA

[5] Saiseikai Yokohamashi Tobu Hosp, Dept Emergency & Crit Care Med, Tsurumi Ku, Yokohama, Kanagawa 2300012, Japan

[6] Keio Univ, Sch Med, Shinjuku Ku, Tokyo 1608582, Japan

[7] Osaka City Gen Hosp, Dept Emergency, Miyakojima ku, Osaka 5340021, Japan

[8] Osaka City Gen Hosp, Crit Care Med Ctr, Miyakojima ku, Osaka 5340021, Japan

[9] Natl Hosp Org Kyoto Med Ctr, Dept Cardiol, Fushimi Ku, Kyoto 6128555, Japan

[10] Tohoku Univ Hosp, Adv Emergency Ctr, Aoba Ku, Sendai, Miyagi 9808574, Japan

[11] Fukuoka Univ Hosp, Dept Emergency & Crit Care Med, Jyonan Ku, Fukuoka 8140180, Japan

[12] Mie Univ Hosp, Crit Care Ctr, Tsu, Mie 5148507, Japan

[13] Gifu Univ Hosp, Adv Crit Care Ctr, Gifu 5011194, Japan

[14] Kyoto Katsura Hosp, Dept Cardiol, Nishikyo Ku, Kyoto 6158256, Japan

[15] Fujisawa City Hosp, Div Emergency Med, Fujisawa, Kanagawa 2518550, Japan

[16] Nara Med Univ Hosp, Adv Crit Care Ctr, Kashihara, Nara 6348522, Japan

[17] Japanese Red Cross Musashino Hosp, Musashino, Tokyo 1808610, Japan

[18] St Lukes Int Hosp, Dept Emergency & Crit Care Med, Chuo Ku, Tokyo 1048560, Japan

[19] Kyoto Univ, Sch Publ Hlth, Dept Hlth Informat, Sakyo Ku, Kyoto 6068501, Japan

[20] Emergency Life Saving Tech Acad, Yahata Nishi Ku, Kitakyushu, Fukuoka 8070874, Japan

[21] Surugadai Nihon Univ Hosp, Dept Cardiol, Chiyoda Ku, Tokyo 1018309, Japan

关键词: Cardiac arrest;    Cardiopulmonary resuscitation;    Emergency department;    Predictors;    Regional brain oxygen saturation;   

DOI  :  10.1016/j.resuscitation.2014.02.012

来源: Elsevier

【 摘 要 】

Aim: To investigate the association between regional brain oxygen saturation (rSO(2)) at hospital arrival and neurological outcomes at 90 days in patients with out-of-hospital cardiac arrest (OHCA). Methods: The Japan-Prediction of neurological Outcomes in patients post cardiac arrest (J-POP) registry is a prospective, multicenter, cohort study to test whether rSO(2) predicts neurological outcomes after OHCA. We measured rSO(2) in OHCA patients immediately after hospital arrival using a near-infrared spectrometer placed on the forehead with non-blinded fashion. The primary endpoint was neurological outcomes at 90 days after OHCA. Results: EMS providers are not permitted to terminate CPR in the field in Japan, and so most patients with OHCA who are treated by EMS personnel are transported to emergency hospitals. Among 1017 OHCA patients, 672 patients including 52 comatose patients with pulses detectable (8%) and 620 cardiac arrest patients (92%) at hospital arrival were enrolled prospectively and consecutively. Twenty-nine patients with good neurological outcome had a significantly higher value of rSO(2) at hospital arrivalthan 643 patients with poor neurological outcome (mean [+/- SD] 55.6 +/- 20.8% vs. 19.7 +/- 11.0%, p < 0.001). Receiver operating curve analysis indicated an optimal rSO(2) cutoff point of >42% for predicting good neurological outcome, with sensitivity 0.79 (95% confidence interval [CI], 0.60-0.92), specificity 0.95 (95% CI, 0.93-0.96), positive predictive value, 0.41 (95% CI, 0.28-0.55), negative predictive value, 0.99 (95% CI, 0.98-1.00), and area under the curve 0.90 (95% CI, 0.88-0.92). Conclusion: The rSO(2) at hospital arrival can predict good neurological outcome at 90 days after OHCA. (C) 2014 The Authors. Published by Elsevier Ireland Ltd. This is an open access article under the CC BY-NC-SA license (http://creativecommons.org/licenses/by-nc-sa/3.0/).

【 授权许可】

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