Improving the neurological prognosis following OHCA using real-time evaluation of cerebral tissue oxygenation

Abstract

Background

The neurological prognosis is poor for patients suffering from out-of-hospital cardiac arrest (OHCA), in the absence of bystander cardio pulmonary resuscitation (CPR), and showing asystole as the initial waveform. However, such patients have the potential of resuming social activity if cerebral tissue oxygen saturation can be preserved.

Case presentation

We recently encountered a 60-year-old man who had suffered an OHCA in the absence of bystander CPR, and who successfully resumed complete social activity despite initial asystole and requiring at least 75 min of chest compressions before return of spontaneous circulation (ROSC). In this case, chest compression was appropriately performed concurrently with real-time evaluation of cerebral tissue oxygenation using near-infrared spectroscopy (NIRS). As a result, the cerebral tissue oxygenation was well maintained, leading to resumption of social activity.

Conclusions

Improved neurological prognoses can be expected if OHCA patients with the potential for social activity resumption are identified, using NIRS, and effective cardiopulmonary and cerebral resuscitation is performed while visually checking CPR quality.

Introduction

The neurological prognosis of patients suffering from out-of-hospital cardiac arrest (OHCA) is poor in cases with initial non-shockable rhythms. Among patients with OHCAs who do not demonstrate return of spontaneous circulation (ROSC) prior to hospital arrival and who do not receive bystander cardiopulmonary resuscitation (CPR), the social activity resumption rate is reportedly < 1% when non-shockable rhythms are the initial waveform [1].

We recently developed the NIRO-Pulse ™ (Hamamatsu Photonics, Tokyo, Japan; Fig. 1), a device capable of depicting changes in hemoglobin concentrations (an indicator of cerebral blood flow), through the use of near-infrared spectroscopy (NIRS), and simultaneously displaying the cerebral tissue oxygenation index (TOI) [2], [3]. Here, we report a case that NIRO-Pulse was used to evaluate CPR efficacy and the TOI was appropriately maintained, leading to the patient's successful resumption of social activity.