Critical Care Medicine | 2019
1474: PREDICTION OF NEUROLOGIC OUTCOME AFTER EXTRACORPOREAL CARDIOPULMONARY RESUSCITATION
Abstract
Learning Objectives: Several studies have reported the effectiveness of extracorporeal cardiopulmonary resuscitation (ECPR) after out-of-hospital cardiac arrest (OHCA). However, predicting neurological outcome of such patients treated with ECPR may be difficult; there is no substantial global consensus on the indication criteria for ECPR. The regional cerebral oxygen saturation (rSO2) value upon hospital arrival can be a predictor of neurological outcome after OHCA. We aimed to investigate the association between rSO2 values and neurological outcome of patients treated with ECPR after OHCA. Methods: We conducted a secondary analysis of prospectively collected registry data of comatose patients who were transferred to 15 hospitals in Japan after OHCA from 2011 to 2013. Among 3,086 consecutive OHCA patients, 1,921 adult patients whose rSO2 was measured with near-infrared spectroscopy were enrolled according to the registry protocol. Among these, 121 patients (6.3%) treated with ECPR were included. We analyzed the association between the rSO2 value upon hospital arrival and patient outcomes. The primary endpoint was good neurological outcome (cerebral performance categories 1 or 2) at 90 days after OHCA. Results: Patient demographics were: mean age, 58.4 y; male, 76.9%; presumed cardiac origin, 78.5%; witnessed arrest, 73.6%. In total, 11 patients (9.1%) had good neurological outcome at 90 days after OHCA. The rSO2 value (%) of patients with good neurological outcome was significantly higher than that of those without good neurological outcome (median [IQR]: 28 [17–52] vs 15 [15–22], p=0.001). A receiver operating characteristic curve analysis indicated an optimal rSO2 cut-off of ≥17% for good neurological outcome (area under the curve 0.76, sensitivity 0.82, specificity 0.66). Considering that the lowest limit of measurable rSO2 was 15%, we stratified patients into two groups; rSO2>15% and rSO2=15%. Good neurological outcome was observed in 19.1% (9/47) and 2.7% (2/74) of patients with rSO2>15% and rSO2=15%, respectively (p=0.032). Conclusions: The rSO2 value upon hospital arrival can be a good predictor of 90-day neurological outcome of patients treated with ECPR after OHCA. This result could provide insights on the indication criteria for ECPR after OHCA.