October 11, 2023European journal of medical researchOpen Access

Skeletal muscle oxygenation during cardiopulmonary resuscitation as a predictor of return of spontaneous circulation: a pilot study

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Why the study?

Brain rSO2 predicts return of spontaneous circulation during CPR, but the feasibility of monitoring skeletal muscle rSO2 changes during resuscitation had not been explored.

Does skeletal muscle oxygenation measured by NIRS during CPR predict return of spontaneous circulation in patients with out-of-hospital cardiac arrest?

Structured PICO

Does skeletal muscle oxygenation measured by NIRS during CPR predict return of spontaneous circulation in patients with out-of-hospital cardiac arrest?

Population

20 adult patients with out-of-hospital cardiac arrest (OHCA), median age 66.0 years, 65% male.

Intervention

Measurement of skeletal muscle and brain regional tissue oxygenation (rSO2) by near-infrared spectroscopy (NIRS) during cardiopulmonary resuscitation (CPR).

Outcome

Feasibility of monitoring skeletal muscle rSO2 and its association with return of spontaneous circulation (ROSC).surrogate

Monitoring skeletal muscle oxygenation during CPR is feasible, and higher rSO2 levels are associated with a greater likelihood of return of spontaneous circulation in OHCA patients.

Implication

Skeletal muscle NIRS monitoring is feasible during CPR; leaves open its prognostic utility and requires validation in larger trials.

Abstract

Background Near-infrared spectroscopy (NIRS) provides regional tissue oxygenation (rSO 2 ) even in pulseless states, such as out-of-hospital cardiac arrest (OHCA). Brain rSO 2 seems to be important predictor of return of spontaneous circulation (ROSC) during cardiopulmonary resuscitation (CPR). Aim of our study was to explore feasibility for monitoring and detecting changes of skeletal muscle rSO 2 during resuscitation. Methods Skeletal muscle and brain rSO 2 were measured by NIRS (SenSmart Model X-100, Nonin, USA) during CPR in adult patient with OHCA. Start (basal) rSO 2 , maximal during CPR (maximal) and difference between maximal–minimal rSO 2 (delta-rSO 2 ), were recorded. Patients were divided into ROSC and NO-ROSC group. Results 20 patients [age: 66.0ys (60.5–79.5), 65% male] with OHCA [50% witnessed, 70% BLS, time to ALS 13.5 min (11.0–19.0)] were finally analyzed. ROSC was confirmed in 5 (25%) patients. Basal and maximal skeletal muscle rSO 2 were higher in ROSC compared to NO-ROSC group [49.0% (39.7–53.7) vs. 15.0% (12.0–25.2), P = 0.006; 76.0% (52.7–80.5) vs. 34.0% (18.0–49.5), P = 0.005, respectively]. There was non-linear cubic relationship between time of collapse and basal skeletal muscle rSO 2 in witnessed OHCA and without BLS (F-ratio = 9.7713, P = 0.0261). There was correlation between maximal skeletal muscle and brain rSO 2 ( n = 18, rho: 0.578, P = 0.0121). Conclusions Recording of skeletal muscle rSO 2 during CPR in patients with OHCA is feasible. Basal and maximal skeletal muscle rSO 2 were higher in ROSC compared to NO-ROSC group. Clinical trial registration number ClinicalTrials.gov, NCT04058925, registered on: 16th August 2019. URL of trial registry record: https://www.clinicaltrials.gov/ct2/show/NCT04058925?titles=Tissue+Oxygenation+During+Cardiopulmonary+Resuscitation+as+a+Predictor+of+Return+of+Spontaneous+Circulation&draw=2&rank=1 .