Assessment of regional cerebral oxygen saturation and ETCO2 in prediction of the return of spontaneous circulation and patients outcome after in-hospital cardiac arrest.

Abstract

Introduction: Cerebral oximetry measurement using near-infrared spectroscopy (NIRS) has been highlighted as a technology that can provide noninvasive information on regional cerebral oxygen saturation (rSO2) during CPR even though its effectiveness has not been fully confirmed. The research focuses on the use of NIRS to predict the return of spontaneous circulation (ROSC) and neurological outcomes.

Objectives: The purpose of the study is to evaluate the validity of using regional cerebral oxygen saturation (rSO2) measurement compared to ETCO2 during CPR to and its association with ROSC, as well as to evaluate the neuroprognostic value of NIRS.

Patients and methods: The study was carried out from January 11, 2023, to January 31, 2024, at the University Hospital, Krakow, Poland. The study group included 104 patients who had in-hospital cardiac arrest. The values of rSO₂ and ETCO₂ were monitored during CPR and for 24 hours after ROSC.

Results: The group of patients who achieved spontaneous circulation during CPR (ROSC group) had significantly higher rSO2 values compared to the non-ROSC group throughout the resuscitation period (63.8% vs 35.6%; P<0.001). Cerebral oximetry demonstrated higher predictive efficacy than ETCO2 as an indicator of ROSC (AUC 0.978 vs 0.815) (P<0.001). The mean rSO2 value ≥66% during CPR was associated with a higher chance of survival within 30 days (AUC 0.992, 95% CI: 0.980-1.000).

Conclusions: The rSO2 value is a more sensitive indicator of ROSC compared to ETCO2. Higher rSO2 values are associated with a higher probability of achieving ROSC. The monitoring of rSO2 during CPR provides prognostic information.