Does chest compression during cardiopulmonary resuscitation provide sufficient cerebral oxygenation?

Abstract

Background/aim: Some of the patients suffering from cardiac arrest (CA) remain in a chronic unconscious state in intensive care units (ICUs). The primary aim of this study was to evaluate the efficacy of chest compression (CC) on cerebral oxygenation during cardiopulmonary resuscitation (CPR). As a secondary goal, we attempted to determine the effects of regional cerebral oxygen saturation (rSO 2) values on consciousness and the survival rate using the Full Outline of Unresponsiveness (FOUR) scoring method. Materials and methods: This observational preliminary study was carried out with 20 patients with CA who were hospitalized in ICUs. The rSO 2 values measured by near-infrared spectroscopy were recorded during CA. FOUR scoring was used to determine the neurological status, severity of disease, and degree of organ dysfunction in survivors. Results: Return of spontaneous circulation (ROSC) was gained in 8 (40%) of 20 patients. Maximum rSO 2 values were higher in survivors than in nonsurvivors (P = 0.005). The mean FOUR score before CA was 11.50 ± 0.8 in survivors, whereas this value was 7.87 ± 0.7 for 1 week after ROSC (P < 0.0001). There was a significant positive correlation between the minimum and mean rSO 2 values and the mean 1-week FOUR scores in survivors (r = 0.811, r = 0.771 and P = 0.015, P = 0.025, respectively). Conclusion: Our results suggest that the maximum rSO 2 values affect ROSC while the minimum and mean rSO 2 values affect the postcardiac arrest neurological outcome.

Adult Advanced Life Support: 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations

“… 75 There was a wide overlap of mean or median cerebral oxygen saturation values between patients with and without ROSC, and this was also reflected in the cohort studies. 77 , 78 , 79 Only 1 observational study 80 compared the rates of ROSC with and without NIRS monitoring and found no difference between the groups. All other studies compared NIRS values in patients who achieved ROSC with those without ROSC.…”

Pediatric Life Support: 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations

“…90,91 There was no consensus on the predictive threshold value of rSco 2 for any outcomes. [92][93][94] A trend of rising rSco 2 (between 7% and 15% from baseline measurement) may be a more reliable predictive factor for ROSC. 90,95,96 The ScopRev also identified 2 observational studies of NIRS in children during CPR.…”

Pediatric Life Support

“… 90 , 91 There was no consensus on the predictive threshold value of rS O 2 for any outcomes. 92 , 93 , 94 A trend of rising rS O 2 (between 7% and 15% from baseline measurement) may be a more reliable predictive factor for ROSC. 90 , 95 , 96 …”