Estimated cerebral oxyhemoglobin as a useful indicator of neuroprotection in patients with post-cardiac arrest syndrome: a prospective, multicenter observational studyReport as inadecuate




Estimated cerebral oxyhemoglobin as a useful indicator of neuroprotection in patients with post-cardiac arrest syndrome: a prospective, multicenter observational study - Download this document for free, or read online. Document in PDF available to download.

Critical Care

, 18:500

First Online: 29 August 2014Received: 28 May 2014Accepted: 20 August 2014

Abstract

IntroductionLittle is known about oxyhemoglobin oxy-Hb levels in the cerebral tissue during the development of anoxic and ischemic brain injury. We hypothesized that the estimated cerebral oxy-Hb level, a product of Hb and regional cerebral oxygen saturation rSO2, determined at hospital arrival may reflect the level of neuroprotection in patients with post-cardiac arrest syndrome PCAS.

MethodsThe Japan Prediction of neurological Outcomes in patients with Post cardiac arrest J-POP registry is a prospective, multicenter, cohort study to test whether rSO2 predicts neurologic outcomes after out-of-hospital cardiac arrest OHCA. This study assessed a subgroup of consecutive patients who fulfilled the J-POP registry criteria and successfully achieved return of spontaneous circulation ROSC from OHCA. The primary outcome measure was the neurologic status at 90 days.

ResultsWe analyzed data from 495 consecutive comatose survivors who were successfully resuscitated from OHCA, including 119 comatose patients with prehospital return of spontaneous circulation ROSC; 24.0% and 376 cardiac arrests at hospital arrival. In total, 75 patients 15.1% presented with good neurologic outcomes. Univariate analysis revealed that the cerebral oxy-Hb levels were significantly higher in patients with good outcomes. Multivariate logistic regression using the backward-elimination method confirmed that the oxy-Hb level was a significant predictor of good neurologic outcomes adjusted odds ratio, 1.27; 95% confidence interval CI, 1.11 to 1.46. Analysis of the area under the receiver operating characteristic curve AUC revealed that an oxy-Hb cut-off of 5.5 provided optimal sensitivity and specificity for predicting good neurologic outcomes AUC, 0.87; 95% CI, 0.83 to 0.91; sensitivity, 77.3%; specificity, 85.6%. The oxy-Hb level appeared to be an excellent prognostic indicator with significant advantages over rSO2 and base excess, according to AUC analysis. The significant trend for good neurologic outcomes was consistent, even in the subgroup of patients who achieved return of spontaneous circulation on hospital arrival 1 quartile, 0; 2 quartile, 16.7%; 3 quartile, 29.4%; 4 quartile, 53.3%; P < 0.05.

ConclusionsThe cerebral oxy-Hb level may predict neurologic outcomes and is a simple and excellent indicator of neuroprotection in patients with PCAS.

Trial registrationUMIN Clinical Trials Registry UMIN000005065. Registered 1 April 2011.

AbbreviationsAUCArea under the receiver operating characteristic curve

CIconfidence interval

CPCcerebral performance category

CPRcardiopulmonary resuscitation

EMSemergency medical service

ICUintensive care unit

J-POPJapan Prediction of neurological Outcomes in patients with Post cardiac arrest

NIRSnear-infrared spectroscopy

NPVnegative predictive value

OHCAout-of-hospital cardiac arrest

ORodds ratio

oxy-Hboxyhemoglobin

PCASpost–cardiac arrest syndrome

PPVpositive predictive value

ROCreceiver operating characteristic

ROSCreturn of spontaneous circulation

rSO2regional cerebral oxygen saturation

SDstandard deviation

Electronic supplementary materialThe online version of this article doi:10.1186-s13054-014-0500-6 contains supplementary material, which is available to authorized users.

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Author: Kei Hayashida - Kei Nishiyama - Masaru Suzuki - Takayuki Abe - Tomohiko Orita - Noritoshi Ito - Shingo Hori - J-POP Registr

Source: https://link.springer.com/







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