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 (rSO2) 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 rSO2 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 rSO2 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 rSO2 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 rSO2 values affect ROSC while the minimum and mean rSO2 values affect the post-cardiac arrest neurological outcome.

Keywords: Cardiopulmonary resuscitation; chest compression; neurological outcome.

Figure 1

The scatterplot of basal, minimum, maximum, and mean rSO2 values for survivors and nonsurvivors. ϯ: Maximum rSO2 values were higher in survivors than in nonsurvivors (P = 0.005). rSO2: Regional cerebral oxygen saturation. Min: Minimum, Max: maximum.

Figure 2

The minimum, maximum, and mean rSO2 (%) values and mean 1-week FOUR scores of each survivor. † Positive correlation between the minimum rSO2 values during CPR and the mean 1-week FOUR scores (r = 0.811, P = 0.015). †† Positive correlation between the mean rSO2 values during CPR and the mean 1-week FOUR scores (r = 0.771, P = 0.025). FOUR: Full Outline of Unresponsiveness, Min: minimum, Max: maximum.

Figure 3

The rSO2 of patient 7 during CPR and after CPR. The caregiver who performed chest compressions for the 7th patient started the chest compressions at the 7th minute and another person took over the compression at the 12th minute. The decrease in rSO2 over this time period is indicated by x arrow. The y arrows indicate rSO2 decreases during frequent rhythm analysis. CPR was terminated at the point indicated by the z arrow.