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Cerebral Oximetry During Pediatric In-Hospital Cardiac Arrest: A Multicenter Study of Survival and Neurologic Outcome
Tia T Raymond1, Ivie D Esangbedo2, Prakadeshwari Rajapreyar3
1Department of Pediatrics, Cardiac Intensive Care, Medical City Children's Hospital, Dallas, TX.
Insights
Near-infrared spectroscopy measuring cerebral regional oxygen saturation (crS o2) during pediatric cardiopulmonary resuscitation is linked to better survival outcomes. Higher crS o2 levels during resuscitation correlate with increased return of spontaneous circulation (ROSC) and survival to hospital discharge (SHD).
Area of Science:
- Pediatric Critical Care Medicine
- Biomedical Engineering
- Resuscitation Science
Background:
- In-hospital cardiac arrest (IHCA) in children has significant mortality and morbidity.
- Monitoring cerebral oxygenation during cardiopulmonary resuscitation (CPR) may offer prognostic insights.
- Cerebral regional oxygen saturation (crS o2) is a noninvasive measure of brain oxygenation.
Purpose of the Study:
- To investigate the association between intra-arrest cerebral regional oxygen saturation (crS o2) and outcomes in pediatric patients undergoing CPR.
- To determine if crS o2 levels during CPR predict return of spontaneous circulation (ROSC) and survival to hospital discharge (SHD).
Main Methods:
- A multicenter, observational study was conducted involving children younger than 18 years with IHCA receiving CPR.
- Near-infrared spectroscopy was used to measure intra-arrest crS o2 during CPR.
- Statistical analyses examined the association of crS o2 metrics with ROSC, SHD, and favorable neurologic outcome (FNO).
Main Results:
- Higher crS o2 values during the entire CPR event, the first 5 minutes, and the last 5 minutes were associated with a higher likelihood of ROSC, SHD, and FNO.
- In infants, higher crS o2 was significantly associated with ROSC, SHD, and FNO after multivariable adjustment.
- The study included 93 patients with 123 IHCA events, with 65% achieving ROSC.
Conclusions:
- Elevated cerebral regional oxygen saturation (crS o2) during pediatric in-hospital cardiac arrest is associated with improved rates of ROSC, SHD, and FNO.
- Intra-arrest crS o2 monitoring shows potential as a real-time, noninvasive predictor of resuscitation success in children.
- These findings support the integration of crS o2 monitoring into pediatric CPR protocols.
Objectives:
To determine if near-infrared spectroscopy measuring cerebral regional oxygen saturation (crS o2 ) during cardiopulmonary resuscitation is associated with return of spontaneous circulation (ROSC) and survival to hospital discharge (SHD) in children.
Design:
Multicenter, observational study.
Setting:
Three hospitals in the pediatric Resuscitation Quality (pediRES-Q) collaborative from 2015 to 2022.
Patients:
Children younger than 18 years, gestational age 37 weeks old or older with in-hospital cardiac arrest (IHCA) receiving cardiopulmonary resuscitation greater than or equal to 1 minute and intra-arrest crS o2 monitoring.
Interventions:
None.
Measurements And Main Results:
Primary outcome was ROSC greater than or equal to 20 minutes without extracorporeal membrane oxygenation. Secondary outcomes included SHD and favorable neurologic outcome (FNO) (Pediatric Cerebral Performance Category 1-2 or no change from prearrest). Among 3212 IHCA events (index and nonindex), 123 met inclusion criteria in 93 patients. Median age was 0.3 years (0.1-1.4 yr) and 31% (38/123) of the cardiopulmonary resuscitation events occurred in patients with cyanotic heart disease. Median cardiopulmonary resuscitation duration was 8 minutes (3-28 min) and ROSC was achieved in 65% (80/123). For index events, SHD was achieved in 59% (54/91) and FNO in 41% (37/91). We determined the association of median intra-arrest crS o2 and percent of crS o2 values above a priori thresholds during the: 1) entire cardiopulmonary resuscitation event, 2) first 5 minutes, and 3) last 5 minutes with ROSC, SHD, and FNO. Higher crS o2 for the entire cardiopulmonary resuscitation event, first 5 minutes, and last 5 minutes were associated with higher likelihood of ROSC, SHD, and FNO. In multivariable analysis of the infant group (age < 1 yr), higher crS o2 was associated with ROSC (odds ratio [OR], 1.06; 95% CI, 1.03-1.10), SHD (OR, 1.04; 95% CI, 1.01-1.07), and FNO (OR, 1.05; 95% CI, 1.02-1.08) after adjusting for presence of cyanotic heart disease.
Conclusions:
Higher crS o2 during pediatric IHCA was associated with increased rate of ROSC, SHD, and FNO. Intra-arrest crS o2 may have a role as a real-time, noninvasive predictor of ROSC.
