Pre-hospital portable monitoring of cerebral regional oxygen saturation (rSO2) in seven patients with out-of-hospital cardiac arrest

Tomoya Hirose; Tadahiko Shiozaki; Junji Nomura; Yasuto Hamada; Keiichi Sato; Kazuya Katsura; Naoki Ehara; Akinori Wakai; Kentaro Shimizu; Mitsuo Ohnishi; Sumito Hayashida; Daikai Sadamitsu; Takeshi Shimazu

doi:10.1186/s13104-016-2239-4

Pre-hospital portable monitoring of cerebral regional oxygen saturation (rSO2) in seven patients with out-of-hospital cardiac arrest

BMC Res Notes. 2016 Aug 31;9(1):428. doi: 10.1186/s13104-016-2239-4.

Authors

Affiliations

¹ Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita, Osaka, 565-0871, Japan. htomoya1979@hp-emerg.med.osaka-u.ac.jp.
² Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita, Osaka, 565-0871, Japan.
³ Chuo Fire Station, Osaka Municipal Fire Department, 2-1-6 Uchihonmachi, Chuo-Ku Osaka-City, Osaka, 540-0026, Japan.
⁴ Traumatology and Critical Care Medical Center, National Hospital Organization Osaka National Hospital, 2-1-14 Hoenzaka, Chuo-Ku Osaka-City, Osaka, 540-0006, Japan.
⁵ Osaka Municipal Fire Department, 1-12-54 Kujo-Minami, Nishi-Ku, Osaka-City, Osaka, 550-8566, Japan.

Abstract

Background: In recent years, measurement of cerebral regional oxygen saturation (rSO2) has attracted attention during resuscitation. However, serial changes of cerebral rSO2 in pre-hospital settings are unclear. The objective of this study was to clarify serial changes in cerebral rSO2 of patients with out-of-hospital cardiac arrest (OHCA) in the pre-hospital setting.

Methods: We recently developed a portable rSO2 monitor that is small (170 × 100 × 50 mm in size and 600 g in weight) enough to carry in pre-hospital settings. The sensor is attached to the patient's forehead by the ELT (Emergency Life-saving Technician), and it monitors rSO2 continuously.

Results: From June 2013 through August 2014, serial changes in cerebral rSO2 in seven patients were evaluated. According to the results of the serial changes in rSO2, four patterns of rSO2 change were found, as follows. Type 1: High rSO2 (around about 60 %) type (n = 1). Initial electrocardiogram was ventricular fibrillation and ROSC (return of spontaneous circulation) could be diagnosed in pre-hospital setting. Her outcome at discharge was Good Recovery (GR). Type 2: Low rSO2 (around about 45-50 %) type (n = 3). They did not get ROSC even once. Type 3: Gradually decreasing rSO2 type (n = 2): ROSC could be diagnosed in hospital, but not in pre-hospital setting. Their outcomes at discharge were not GR. Type 4: other type (n = 1). In this patient with ROSC when ELT started cerebral rSO2 measurement, cerebral rSO2 was 67.3 % at measurement start, it dropped gradually to 54.5 %, and then rose to 74.3 %. The cerebral oxygenation was impaired due to possible cardiac arrest again, and after that, ROSC led to the recovery of cerebral blood flow.

Conclusion: We could measure serial changes in cerebral rSO2 in seven patients with OHCA in the pre-hospital setting. Our data suggest that pre-hospital monitoring of cerebral rSO2 might lead to a new resuscitation strategy.

Keywords: Emergency life-saving technician; Out-of-hospital cardiac arrest; Portable rSO2 monitor; Pre-hospital; Regional oxygen saturation.

MeSH terms

Adult
Aged
Aged, 80 and over
Brain / metabolism*
Emergency Medical Technicians
Female
Hospitalization
Humans
Male
Middle Aged
Monitoring, Physiologic / methods*
Out-of-Hospital Cardiac Arrest / metabolism*
Oxygen / metabolism*
Treatment Outcome

Substances

Oxygen