Resuscitation
Volume 83, Issue 1 , Pages 46-50, January 2012

Regional cerebral oxygen saturation on hospital arrival is a potential novel predictor of neurological outcomes at hospital discharge in patients with out-of-hospital cardiac arrest☆

  • Noritoshi Ito

      Affiliations

    • Senri Critical Care Medical Center, Osaka Saiseikai Senri Hospital, 1-1-6 Tsukumodai, Suita, Osaka 565-0862, Japan
    • Corresponding Author InformationCorresponding author. Tel.: +81 6 6871 0121; fax: +81 6 6871 0130.
    • ,
  • Shinsuke Nanto

      Affiliations

    • Department of Advanced Cardiovascular Therapeutics, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan
    • ,
  • Ken Nagao

      Affiliations

    • Department of Cardiology, Surugadai Nihon University Hospital, 1-8-13 Kanda-Surugadai, Chiyoda-ku, Tokyo 101-8309, Japan
    • ,
  • Tetsuo Hatanaka

      Affiliations

    • Emergency Life Saving Technique Academy, 3-8-1 Oura, Yahata-nishi-ku, Kitakyushu, Fukuoka 807-0874, Japan
    • ,
  • Kei Nishiyama

      Affiliations

    • Department of Primary Care and Emergency Medicine, Kyoto University Graduate School of Medicine, 54 Kawara-machi, Seigoin, Sakyo-ku, Kyoto 606-8507, Japan
    • ,
  • Tatsuro Kai

      Affiliations

    • Senri Critical Care Medical Center, Osaka Saiseikai Senri Hospital, 1-1-6 Tsukumodai, Suita, Osaka 565-0862, Japan

Received 2 May 2011; received in revised form 20 September 2011; accepted 26 October 2011. published online 02 November 2011.

Article Outline

Abstract 

Aim To investigate the association between regional brain oxygen saturation (rSO2) on hospital arrival and neurological outcomes at hospital discharge in patients with out-of-hospital cardiac arrest (OHCA).

Methods A prospective cohort study was conducted, registering 179 patients with OHCA who were referred to Senri Critical Care Medical Centre between April 2009 and June 2010. Of these patients, 92 met the inclusion criteria. The primary end point was “neurological outcomes” at hospital discharge according to the “Utstein style” guidelines.

Results The overall rate of good neurological outcome at hospital discharge was 14% (n=13). Sixty-one patients with rSO2 ≤25% showed poor neurological outcome in the receiver operating curve analysis (optimal cut-off point, 25%; sensitivity, 0.772; specificity, 1.000; positive predictive value, 1.000; area under the curve (AUC), 0.919; p<0.0001). The AUC for rSO2 was greater than that for base excess (p=0.0461) or lactate (p=0.0128) measured on hospital arrival. Since rSO2 >40% was previously collated with good neurological outcome after cardiovascular surgery, we categorised our patients into three groups in a post hoc analysis: patients with rSO2 ≤25% (n=61); patients with rSO2 26–40% (n=9) and patients with rSO2 >40% (n=22). Patients with good neurological outcome were as follows: 0 (0%)/61 with rSO2 ≤25%; two (22.2%)/9 with rSO2 26–40% and 11 (50.0%)/22 with rSO2 >40% (p<0.0001).

Conclusion rSO2 on hospital arrival may help predict neurological outcomes at hospital discharge in patients with OHCA.

Keywords: Cardiac arrest, Cardiopulmonary resuscitation, Emergency department, Predictors, Regional brain oxygen saturation

 

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1. Introduction 

Brain protection therapy for patients with out-of-hospital cardiac arrest (OHCA) has greatly improved in recent years due to the development of emergency post-cardiac arrest interventions, for example, mild therapeutic hypothermia, early percutaneous coronary intervention and extracorporeal cardiopulmonary resuscitation (CPR).1, 2, 3, 4 However, the indications for these costly interventions have not yet been established mainly because of difficulty in prognosticating neurological outcomes at hospital discharge on hospital arrival.5, 6, 7, 8, 9, 10 Importantly, there is little time to consider whether or not highly intensive post-cardiac arrest interventions should be performed. A prognostic index that can be evaluated on hospital arrival3 is needed to determine treatment strategies as quickly as possible after OHCA. Although many studies have identified factors associated with poor functional outcome after resuscitation, no study has shown a reliable predictor of neurological outcomes at hospital discharge.

Previous reports have described that an inadequate intra-operative value of regional cerebral oxygen saturation (rSO2) is a significant predictor of postoperative neurological complications after cardiovascular surgery.11, 12, 13, 14 rSO2 can be measured non-invasively in real time by near-infrared spectroscopy (NIRS). NIRS does not require vascular pulsation and can measure rSO2 even in patients with hypotension, hypothermia and/or circulatory arrest. We hypothesised that neurological outcomes at hospital discharge in patients with OHCA can be predicted by the rSO2 values measured on hospital arrival.

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2. Methods 

2.1. Study design and setting 

Senri Critical Care Medical Centre is one of the largest emergency departments in western Japan where approximately 1 million people of both urban and rural communities reside in a 275km2 area, with population densities of ∼28,710 persons per km2; there are 23 fire stations with a corresponding number of emergency dispatch centres. Emergency medical services (EMSs) at these fire stations are provided by municipal governments. All OHCA patients are treated by EMSs personnel and then transported to medical institutions.15 The team members are trained in all aspects of advanced life support (ALS) procedures for prehospital emergency care.4, 16The CPR protocol at this centre is as described below. After arrival at the emergency department, all patients receive ALS in accordance with the national guidelines for resuscitation. Patients whose initially documented electrocardiograph (ECG) rhythm was ventricular fibrillation (VF) or pulseless ventricular tachycardia (VT) receive extracorporeal CPR using extracorporeal circulatory support or cardiopulmonary bypass through the Capiox Emergency Bypass System (Terumo, Inc., Tokyo, Japan) if sustained return of spontaneous circulation (sustained return of spontaneous circulation (ROSC): restoration of palpable pulse that is sustained for at least 20min) is not obtained with standard ALS. In the patient in whom sustained ROSC was obtained, mild hypothermia therapy is induced if his/her systolic blood pressure increases above 90mmHg and the Glasgow coma scale score is between 3 and 6.17, 18, 19

2.2. Data collection 

Using the Utstein style,20, 21, 22, 23, 24 data were collected prospectively from consecutive patients with OHCA from 1 April 2009 to 30 June 2010 at our centre in an attempt to verify the capability of rSO2 on hospital arrival to predict neurological outcomes at hospital discharge. Cardiac arrest was defined as the absence of spontaneous respiration, palpable pulse and responsiveness to stimuli.20, 21, 22, 23, 24, 25 The exclusion criteria were as follows: the presence of palpable pulse on hospital arrival; age under 18 years; previously known severe irreversible brain damage; terminal malignancy; a traumatic origin and previous completion of a “do not attempt resuscitation” form.

Data in this registry include patient demographics, prehospital information and in-hospital information. Prehospital information was collected from the EMSs database. Baseline characteristics and in-hospital information were collected from medical charts and databases.

2.3. NIRS procedures 

An NIRS device (INVOS; Covidien, Boulder, CO) had been set ready to operate before patient arrival.26, 27, 28 On hospital arrival, the patient's skin was thoroughly cleaned and two disposable sensors were carefully applied bilaterally to the patient's forehead. The rSO2 values stabilised within several seconds after placement of the NIRS probes. The values were then monitored for at least 1min, and the lower of two rSO2 values measured for analysis was adopted because previous studies had demonstrated that the lower value relates to poor neurological outcome.11, 12, 13, 14 Clinical staff performed routine post-cardiac arrest interventions regardless of these measurements.

2.4. Base excess and lactate 

Concurrently with the measurement of rSO2 on hospital arrival, arterial whole blood was sampled anaerobically and then analysed with a commercially available US Food and Drug Administration-approved device (RAPIDLab 1265; Siemens Healthcare Diagnostics, IL, USA) in the laboratory of Osaka Saiseikai Senri Hospital. Base excess (BE) was determined according to the equation derived from The National Committee for Clinical Laboratory Standards (NCCLS) recommendations (CLSI Document C46-A; (Vol.21); 2001), and lactate was measured with lactate biosensors.

2.5. Study end points 

The primary end point was “neurological outcomes” at hospital discharge. Neurological outcomes were categorised in accordance with Glasgow–Pittsburgh Cerebral Performance Categories at hospital discharge described in the “Utstein style” guidelines.21, 22, 23, 24, 25, 26 According to the “Utstein style” guidelines,20, 21, 22, 23, 24, 25 cerebral performance category (CPC) levels were defined as follows: CPC 1 (good performance) and CPC 2 (moderate disability) as “good neurological outcome”; and CPC 3 (severe disability), CPC 4 (vegetative state) and CPC 5 (brain death or death) as “poor neurological outcome”. CPC was evaluated by more than two physicians in charge.

2.6. Ethical considerations 

The study protocol complied with the guidelines for epidemiologic studies that had been issued by the Ministry of Health, Labour and Welfare of Japan and was approved by the Ethical Committee at Osaka Saiseikai Senri Hospital. Every patient received the standard care available at the hospital, and no patient received an experimental intervention. In light of these safeguards, the Ethical Committee approved this study and permitted the study to be exempt from the acquisition of oral or written consent.

2.7. Statistical analysis 

The Wilcoxon signed-rank test was performed for paired comparisons. The unpaired t-test or Mann–Whitney test was conducted for unpaired comparisons. The chi-square test was made to examine differences between categorical variables. The receiver operating curve (ROC) analysis was performed to evaluate the predictive accuracy of poor neurological outcome at hospital discharge. A two-tailed value of p<0.05 was considered statistically significant. All statistical analyses were performed using the Statistical Analysis Software (SAS) software version 9.2 (SAS Institute Inc., Cary, NC, USA). The authors had full access to the data and take responsibility for its integrity. All authors have read and agreed to the manuscript as written.

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3. Results 

3.1. General characteristics 

During the study period, the full registry collected data on 179 patients who were referred to our centre. Among them, 13 patients were excluded because of cardiac arrest caused by trauma, one patient because of age under 18 years, 12 patients because of a “do not attempt resuscitation order” and 61 patients because of palpable pulse on hospital arrival. In the present study, therefore, we enrolled a total of 92 consecutive patients (Fig. 1). Table 1 shows the demographic characteristics of the enrolled 92 patients.

Table 1. Characteristics of patients with out-of-hospital cardiac arrest.
CharacteristicsTotal (n=92)
Age, mean (SD), years71 (13)
Male, n (%)61 (66%)
Locations of cardiac arrest, n (%)
Home54 (59%)
Nursing home/assisted living13 (14%)
Public building10 (11%)
Street9 (10%)
Others6 (6%)
Types of origin, n (%)a
Cardiac57 (62%)
Noncardiac35 (38%)
Type of bystander-witness status, n (%)
No witness32 (35%)
Family members33 (36%)
Others27 (29%)
Initially documented rhythms on the scene of cardiac arrest, n (%)
VF/pulseless VT19 (21%)
PEA39 (42%)
Asystole34 (37%)
Prehospital procedures
Advanced airway devices84 (91%)
Intravenous adrenaline78 (85%)
Defibrillation18 (20%)
Transient ROSC before hospital arrival, n (%)37 (40%)
Call to hospital arrival, median (IQR), min40 (31–49)
Rhythms at rSO2 measurement, n (%)
VF/pulseless VT18 (20%)
PEA36 (39%)
Asystole38 (41%)
Procedures after hospital arrival
Standard ALS92 (100%)
Extracorporeal CPR20 (22%)
Mild hypothermia therapy33 (36%)

ALS, advanced cardiac life-support; CPR, cardiopulmonary resuscitation; IQR, interquartile range; PEA, pulseless electrical activity; ROSC, return of spontaneous circulation; rSO2, regional cerebral oxygen saturation; SD, standard deviation; VF, ventricular fibrillation; VT, ventricular tachycardia.

aCardiac or noncardiac arrest was determined clinically by the physician in charge.

Follow-up data were obtained for all patients in the study (Table 2). Of the enrolled 92 patients, 62 patients (67%) including 39 who had achieved transient ROSC were pronounced dead in the emergency department. Of the remaining 30 patients, 10 patients (11%) died after admission to the hospital and 20 patients (22%) survived to hospital discharge, with CPC 1 in 12 patients (13%), CPC 2 in one patient (1%), CPC 3 in one patient (1%) and CPC 4 in six patients (7%). Of the 92 patients with cardiac arrest on hospital arrival, 92 patients (100%) received ALS, 20 patients (22%) received extracorporeal CPR and 33 patients (36%) received brain hypothermia therapy after hospital arrival.

Table 2. Neurological outcomes of patients with out-of-hospital cardiac arrest at hospital discharge.
Outcomesn (%)
Survival at hospital discharge (CPC 1–4)20 (22%)
CPC 1, good performance12 (13%)
CPC 2, moderate disability1 (1%)
CPC 3, severe disability1 (1%)
CPC 4, coma or vegetative state6 (7%)
Deaths (CPC 5)72 (78%)
Deaths pronounced in the emergency department62 (67%)
Deaths after hospital admission10 (11%)

CPC, cerebral performance category.

Glasgow-Pittsburgh CPC levels according to the “Utstein style” guidelines, CPC 1 (good performance) and 2 (moderate disability) as good neurological outcome; and CPC 3 (severe disability), CPC 4 (vegetative state), and CPC 5 (brain death or death) as poor neurological outcome at hospital discharge.

3.2. Regional cerebral oxygen saturation and other examinations 

We had no technical difficulty in placing the sensors according to the study protocol, and the interval between hospital arrival and application of the NIRS probes was 3min or less in all patients. Thirteen patients with good neurological outcome at hospital discharge had significantly higher rSO2 values on hospital arrival than 79 patients with poor neurological outcome (52±13% vs. 24±14%, p<0.00001; Fig. 2A).

  • View full-size image.
  • Fig. 2. 

    Comparison of the good and poor neurological outcome groups with respect to rSO2, BE and lactate (A) rSO2, (B) BE, (C) Lactate. Open circles represent patients with good neurological outcome, and closed circles represent those with poor neurological outcome. Data are expressed as mean (standard deviation) (the Mann–Whitney test). rSO2, regional cerebral oxygen saturation; BE, base excess.

The results from the ROC analysis to predict poor neurological outcome at hospital discharge were as follows: optimal cut-off point, 25%; sensitivity, 0.772 (95% confidence interval (CI), 0.664–0.859); specificity, 1.000 (95% CI, 0.753–1.000); positive predictive value, 1.000 (95% CI, 0.941–1.000); area under the curve (AUC), 0.919 (95% CI, 0.861–0.976) and p<0.0001 (Table 3).

Table 3. Results of the area under the receiver operating curve analysis to predict poor neurological outcome at hospital discharge.
Optimal cutoffAUC (95% CI)p ValueSensitivity (95% CI)Specificity (95% CI)PPV (95% CI)
rSO225%0.919 (0.861–0.976)<0.00010.772 (0.664–0.859)1.000 (0.753–1.000)1.000 (0.941–1.000)
BE−9.9mmoll−10.736 (0.563–0.910)0.00180.937 (0.858–0.979)0.539 (0.251–0.808)0.925 (0.844–0.972)
Lactate11.8mmoll−10.711 (0.546–0.871)0.00630.595 (0.479–0.704)0.769 (0.462–0.950)0.940 (0.835–0.988)

AUC, area under the curve; BE, base excess; CI, confidence interval; PPV, positive predictive value; rSO2, regional cerebral oxygen saturation.

Patients with good neurological outcome at hospital discharge had significantly higher BE and lower lactate values than those with poor neurological outcome (−11.6±10.2mmoll−1 vs. −19.1±6.9mmoll−1, p=0.007; 8.9±4.7mmoll−1 vs. 12.5±4.6mmoll−1, p=0.016, respectively; Fig. 2B,C). The AUCs for rSO2, BE and lactate to differentiate poor from good neurological outcome at hospital discharge were 0.919 (95% CI, 0.861–0.976), 0.736 (95% CI, 0.563–0.910) and 0.711 (95% CI, 0.546–0.871), respectively (Table 3). The AUC was significantly greater with respect to the prediction of poor neurological outcome for rSO2 than that for BE (p=0.0461) or for lactate (p=0.0128).

Since rSO2 >40% had previously shown a correlation with good neurological outcome after cardiovascular surgery,13, 14 we categorised our patients into three groups in a post hoc analysis: patients with rSO2≤25% (n=61); patients with rSO2 26–40% (n=9) and patients with rSO2>40% (n=22). Subsequently, we compared these groups with respect to neurological outcomes (Fig. 3); patients with good neurological outcome at hospital discharge were as follows: 0 (0%)/61 with rSO2≤25%; two (22.2%)/9 with rSO2 26–40% and 11 (50.0%)/22 with rSO2>40%. A significant difference (p<0.0001) was found.

  • View full-size image.
  • Fig. 3. 

    Comparison of the rSO2 groups with respect to good neurological outcome at hospital discharge The chi-square test was used to examine differences between categorical variables. rSO2, regional cerebral oxygen saturation.

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4. Discussion 

4.1. Regional cerebral oxygen saturation and neurological outcomes at hospital discharge 

This is the first prospective cohort study to demonstrate that rSO2 measured on hospital arrival in patients with OHCA may help predict neurological outcomes at hospital discharge. The rSO2 values showed a significantly positive correlation with good neurological outcome at hospital discharge (Fig. 3). The ROC analysis revealed that the rSO2 values on hospital arrival identified, with high specificity and high predictivity, patients with OHCA who were likely to have poor neurological outcome at hospital discharge. Therefore, the preservation of high rSO2 values during the prehospital CPR period is considered to be one of the main requisites in resuscitation, although the causality between the initial rSO2 values and subsequent neurological outcomes remains unestablished.

In cardiac arrest patients, clinically relevant recovery depends heavily on the restoration of their cerebral function, which in turn depends on two major factors: (1) to prevent or alleviate global ischaemia during the “no-flow time” and “low-flow (CPR) time” and (2) to decrease the degree of post-reperfusion injury of the brain. In this study, we focussed on the first factor and speculated that the rSO2 values on hospital arrival may reflect the degree of global ischaemia that has persisted during the prehospital period. In patients with the high initial rSO2 values, cerebral perfusion was relatively well maintained from the onset of cardiac arrest to the rSO2 measurement in the emergency department. Therefore, good neurological outcome might be expected.

4.2. Regional cerebral oxygen saturation and other examinations 

The AUC was significantly greater for rSO2 than for BE and lactate which had separately been shown to be associated with poor neurological outcome.29, 30 In addition, we demonstrated that the rSO2 assessment is superior to the BE and lactate assessments because the former can be measured on hospital arrival. We were able to measure rSO2 non-invasively within 3min after hospital arrival. Collection of blood samples for BE and lactate measurements was initiated on hospital arrival. However, it took at least 10min to obtain the BE and lactate values at the hospital,31, 32 because of technical difficulties associated with blood sampling in patients with OHCA.

4.3. Emergency medical problems 

In OHCA patients, the early initiation of post-cardiac arrest interventions such as mild therapeutic hypothermia, early percutaneous coronary intervention and extracorporeal CPR is required to manage post-cardiac arrest syndromes associated with reperfusion brain injury, myocardial dysfunction, systemic ischaemia/reperfusion response and persistent precipitating pathology, as well as to maintain brain and other organs’ functions.1, 2, 3 However, the indications for these costly interventions have not yet been established, mainly because of difficulty in predicting the patient's neurological outcomes on hospital arrival. The NIRS probes placed in resuscitation attempts may indicate that the ongoing resuscitation is unlikely to sustain the adequate cerebral blood flow. This study suggests that rSO2 ≤25% may be a potential early indicator of futile resuscitation attempts, and we consider that the preservation of the rSO2 values on hospital arrival will improve neurological outcomes at hospital discharge.

4.4. Limitations 

This study has several limitations. First, our findings should be considered preliminary because of the small sample size: there were only 13 patients with good neurological outcome in the present study, and a study that includes a large number of patients in the specific subgroup is essential to validate our findings. Second, we had no information on the duration of low rSO2 values in prehospital resuscitation, a potentially important predictor of poor neurological outcome at hospital discharge. Third, OHCA patients with a palpable pulse on hospital arrival were excluded from this study; therefore, we did not analyse the predictive value of rSO2 for neurological outcomes in patients with a palpable pulse. A further study will be needed to investigate whether or not rSO2 in patients with sustained ROSC is effective in predicting neurological outcomes or is helpful as a therapeutic target. Fourth, since the primary end point of this study was “neurological outcomes” at hospital discharge, we did not evaluate the correlation between the success rate of ROSC and the initial rSO2 values on hospital arrival. Fifth, it is recommended that clinical staff should be blind to the results of index tests.33 In this study, we could not blind readers of the rSO2 values to the results of other tests and to any other clinical information because the rSO2 evaluation is real-time monitoring which needs visual confirmation. However, we performed routine CPR including extracorporeal CPR and therapeutic hypothermia according to the standard protocol irrespective of the rSO2 values obtained. Sixth, neurological outcomes and other outcomes (e.g., survival) are clearly dependent on both the quality of initial resuscitation and intensive care unit (ICU)-based post-resuscitation care as described in the 2008 and 2010 American Heart Association/European Resuscitation Council guidelines. Therefore, the meticulous monitoring of rSO2 after hospital arrival is crucial, with possible further improvements in neurological outcomes at hospital discharge if the above post-resuscitation care to preserve an rSO2 value that is equal to or above the optimal cut-off level is provided. However, the relationship between rSO2 during ICU-based post-resuscitation care and neurological prognosis at hospital discharge was not examined in the present study, although we performed standardised post-resuscitation care according to the guidelines regardless of the rSO2 values obtained. Therefore, the examination of the relevant relationship constitutes a challenge to be addressed in the future.

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5. Conclusion 

Although small sample size precludes definitive conclusions and a validation study in larger and more diverse patient groups is warranted, our data suggest that rSO2 may help predict not only poor but also good neurological outcome at hospital discharge in OHCA patients.

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Conflict of interest statement 

All authors declare no conflicts of interest.

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Funding 

None.

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Acknowledgements 

We are greatly indebted to all of Osaka Saiseikai Senri Hospital personnel and Tetsuhisa Kitamura, MD (Kyoto University Health Service).

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Appendix A. Supplementary data 

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References 

  1. Nagao K, Hayashi N, Kanmatsuse K, et al. Cardiopulmonary cerebral resuscitation using emergency cardiopulmonary bypass, coronary reperfusion therapy and mild hypothermia in patients with cardiac arrest outside the hospital. J Am Coll Cardiol. 2000;36:776–783
  2. Nichol G, Aufderheide TP, Eigel B, et al. Regional systems of care for out-of-hospital cardiac arrest: a policy statement from the American Heart Association. Circulation. 2010;121:709–729
  3. Neumar RW, Nolan JP, Adrie C, et al. Post-cardiac arrest syndrome: epidemiology, pathophysiology, treatment, and prognostication. A consensus statement from the International Liaison Committee on Resuscitation (American Heart Association, Australian and New Zealand Council on Resuscitation, European Resuscitation Council, Heart and Stroke Foundation of Canada, InterAmerican Heart Foundation, Resuscitation Council of Asia, and the Resuscitation Council of Southern Africa); the American Heart Association Emergency Cardiovascular Care Committee; the Council on Cardiovascular Surgery and Anesthesia; the Council on Cardiopulmonary, Perioperative, and Critical Care; the Council on Clinical Cardiology; and the Stroke Council. Circulation. 2008;118:2452–2483
  4. Field JM, Hazinski MF, Sayre MR, et al. Part 1: executive summary: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2010;122:S640–S656
  5. Booth CM, Boone RH, Tomlinson G, Detsky AS. Is this patient dead, vegetative, or severely neurologically impaired? Assessing outcome for comatose survivors of cardiac arrest. JAMA. 2004;291:870–879
  6. Wijdicks EF, Hijdra A, Young GB, Bassetti CL, Wiebe S. Practice parameter: prediction of outcome in comatose survivors after cardiopulmonary resuscitation (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology. 2006;67:203–210
  7. Levy DE, Caronna JJ, Singer BH, Lapinski RH, Frydman H, Plum F. Predicting outcome from hypoxic-ischemic coma. JAMA. 1985;253:1420–1426
  8. Zandbergen EG, de Haan RJ, Stoutenbeek CP, Koelman JH, Hijdra A. Systematic review of early prediction of poor outcome in anoxic-ischaemic coma. Lancet. 1998;352:1808–1812
  9. Edgren E, Hedstrand U, Kelsey S, Sutton-Tyrrell K, Safar P. Assessment of neurological prognosis in comatose survivors of cardiac arrest. Lancet. 1994;343:1055–1059
  10. Bottiger BW, Arntz HR, Chamberlain DA, et al. Thrombolysis during resuscitation for out-of-hospital cardiac arrest. N Engl J Med. 2008;359:2651–2662
  11. Higami T, Kozawa S, Asada T, et al. Retrograde cerebral perfusion versus selective cerebral perfusion as evaluated by cerebral oxygen saturation during aortic arch reconstruction. Ann Thorac Surg. 1999;67:1091–1096
  12. Newman MF, Kirchner JL, Phillips-Bute B, et al. Longitudinal assessment of neurocognitive function after coronary-artery bypass surgery. N Engl J Med. 2001;344:395–402
  13. Yao FS, Tseng CC, Ho CY, Levin SK, Illner P. Cerebral oxygen desaturation is associated with early postoperative neuropsychological dysfunction in patients undergoing cardiac surgery. J Cardiothorac Vasc Anesth. 2004;18:552–558
  14. Murkin JM, Adams SJ, Novick RJ, et al. Monitoring brain oxygen saturation during coronary bypass surgery: a randomized, prospective study. Anesth Analg. 2007;104:51–58
  15. Kitamura T, Iwami T, Kawamura T, Nagao K, Tanaka H, Hiraide A. Nationwide public-access defibrillation in Japan. N Engl J Med. 2010;362:994–1004
  16. Japanese Guidelines for Emergency Care and Cardiopulmonary Resuscitation, 3rd ed. Tokyo, Japan: Health Shuppansha, 2007.
  17. Teasdale G, Jennett B. Assessment of coma and impaired consciousness. A practical scale. Lancet. 1974;2:81–84
  18. Nagao K, Miki T, Okamoto K, Nitobe H. Blood cooling system using coil cooling for brain hypothermia. Jpn J Acute Med. 1999;23:674–704
  19. Nolan JP, Morley PT, Vanden Hoek TL, et al. Therapeutic hypothermia after cardiac arrest: an advisory statement by the advanced life support task force of the International Liaison Committee on Resuscitation. Circulation. 2003;108:118–121
  20. Cummins RO, Chamberlain DA, Abramson NS, et al. Recommended guidelines for uniform reporting of data from out-of-hospital cardiac arrest: the Utstein Style, Task Force of the American Heart Association, the European Resuscitation Council, the Heart and Stroke Foundation of Canada, and the Australian Resuscitation Council. Ann Emerg Med. 1991;20:861–874
  21. Safar P. Cerebral resuscitation after cardiac arrest: a review. Circulation. 1986;74:IV138–IV153
  22. Jacobs I, Nadkarni V, Bahr J, et al. Cardiac arrest and cardiopulmonary resuscitation outcome reports: update and simplification of the Utstein templates for resuscitation registries: a statement for healthcare professionals from a task force of the International Liaison Committee on Resuscitation (American Heart Association, European Resuscitation Council, Australian Resuscitation Council, New Zealand Resuscitation Council, Heart and Stroke Foundation of Canada, InterAmerican Heart Foundation, Resuscitation Councils of Southern Africa). Circulation. 2004;110:3385–3397
  23. Cummins RO, Chamberlain DA, Abramson NS, et al. Recommended guidelines for uniform reporting of data from out-of-hospital cardiac arrest: the Utstein Style. A statement for health professionals from a task force of the American Heart Association, the European Resuscitation Council, the Heart and Stroke Foundation of Canada, and the Australian Resuscitation Council. Circulation. 1991;84:960–975
  24. Kitamura T, Iwami T, Kawamura T, Nagao K, Tanaka H, Hiraide A. Bystander-initiated rescue breathing for out-of-hospital cardiac arrests of noncardiac origin. Circulation. 2010;122:293–299
  25. Bobrow BJ, Spaite DW, Berg RA, et al. Chest compression-only CPR by lay rescuers and survival from out-of-hospital cardiac arrest. JAMA. 2010;304:1447–1454
  26. Jobsis FF. Noninvasive, infrared monitoring of cerebral and myocardial oxygen sufficiency and circulatory parameters. Science. 1977;198:1264–1267
  27. Edmonds HL, Rodriguez RA, Audenaert SM, Austin EH, Pollock SB, Ganzel BL. The role of neuromonitoring in cardiovascular surgery. J Cardiothorac Vasc Anesth. 1996;10:15–23
  28. Kim MB, Ward DS, Cartwright CR, Kolano J, Chlebowski S, Henson LC. Estimation of jugular venous O2 saturation from cerebral oximetry or arterial O2 saturation during isocapnic hypoxia. J Clin Monit Comput. 2000;16:191–199
  29. Takasu A, Sakamoto T, Okada Y. Arterial base excess after CPR: the relationship to CPR duration and the characteristics related to outcome. Resuscitation. 2007;73:394–399
  30. Aduen J, Bernstein WK, Khastgir T, et al. The use and clinical importance of a substrate-specific electrode for rapid determination of blood lactate concentrations. JAMA. 1994;272:1678–1685
  31. Howanitz PJ, Cembrowski GS, Steindel SJ, Long TA. Physician goals and laboratory test turnaround times. A College of American Pathologists Q-Probes study of 2763 clinicians and 722 institutions. Arch Pathol Lab Med. 1993;117:22–28
  32. Fermann GJ, Suyama J. Point of care testing in the emergency department. J Emerg Med. 2002;22:393–404
  33. Bossuyt PM, Reitsma JB, Bruns DE, et al. The STARD statement for reporting studies of diagnostic accuracy: explanation and elaboration. Ann Intern Med. 2003;138:W1–W12

☆ A Spanish translated version of the abstract of this article appears as Appendix in the final online version at doi:10.1016/j.resuscitation.2011.10.016.

PII: S0300-9572(11)00615-0

doi:10.1016/j.resuscitation.2011.10.016

Resuscitation
Volume 83, Issue 1 , Pages 46-50, January 2012

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