Assessment of regional cerebral oxygen saturation and end‑tidal carbon dioxide in prediction of a return of spontaneous circulation and patient 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 satura‑ tion (rSO2) during cardiopulmonary resuscitation (CPR), even though its effectiveness has not been fully confirmed. The research focused on the use of NIRS to predict the return of spontaneous circulation (ROSC) and neurological outcomes. ObjECTIvEs The purpose of the study was to evaluate the validity of rSO2 vs end‑tidal carbon dioxide (ETCO2) measurement during CPR and its association with ROSC, as well as to assess the neuroprog‑ nostic value of NIRS. PATIENTs ANd mEThOds The study was carried out from January 11, 2023 to January 31, 2024, at the University Hospital, Kraków, Poland. The study group included 104 patients who experienced 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 higher rSO2 values than the non‑ROSC group throughout the resuscitation period (63.8% vs 35.6%; P <0.001). Cerebral oximetry demonstrated higher predictive efficacy of rSO2 than ETCO2 as an indicator of ROSC (area under the curve [AUC], 0.978 vs 0.815; P <0.001). The mean rSO2 value equal to or above 66% during CPR was associated with a higher chance of survival within 30 days (AUC, 0.992; 95% CI, 0.98–1). CONCLusIONs The rSO2 value is a more sensitive indicator of ROSC than ETCO2. Higher rSO2 values are associated with a higher probability of achieving ROSC. The monitoring of rSO2 during CPR provides prognostic information.