Comparison of manual and mechanical chest compression techniques using cerebral oximetry in witnessed cardiac arrests at the emergency department: A prospective, randomized clinical study

• Published in: The American journal of emergency medicine Vol. 41; pp. 163 - 169
• Main Authors: Baloglu Kaya, Filiz, Acar, Nurdan, Ozakin, Engin, Canakci, Mustafa Emin, Kuas, Caglar, Bilgin, Muzaffer
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.03.2021; Elsevier Limited
• Subjects: Aged; Aged, 80 and over; Blood pressure; Brain - metabolism; Cardiopulmonary Resuscitation - methods; Chest; Compression; Emergency medical care; Emergency Service, Hospital; Female; Heart; Heart Arrest - therapy; Heart attacks; Heart rate; Humans; Infrared spectroscopy; Male; Middle Aged; Normal distribution; Oximetry; Oxygen; Oxygen saturation; Patients; Perfusion; Prospective Studies; Pulse oximetry; Sensors; Standard deviation; Vital signs; United States > US
• ISSN: 0735-6757; 1532-8171
• DOI: 10.1016/j.ajem.2020.06.031

We aimed to compare regional cerebral oxygen saturation (rSO2) levels during cardiopulmonary resuscitation (CPR), performed either manually or using a mechanical chest compression device (MCCD), in witnessed cardiac arrest cases in the emergency department (ED), and to evaluate the effects of both the CPR methods and perfusion levels on patient survival and neurological outcomes. This single-center, randomized study recruited patients aged ≥18 years who had witnessed a cardiopulmonary arrest in the ED. According to the relevant guidelines, CPR was performed either manually or using an MCCD. Simultaneously, rSO2 levels were continually measured with near-infrared spectroscopy. Seventy-five cases were randomly distributed between the MCCD (n = 40) and manual CPR (n = 35) groups. No significant difference in mean rSO2 levels was found between the MCCD and manual CPR groups (46.35 ± 14.04 and 46.60 ± 12.09, respectively; p = 0.541). However, a significant difference in rSO2 levels was found between patients without return of spontaneous circulation (ROSC) and those with ROSC (40.35 ± 10.05 and 50.50 ± 13.44, respectively; p < 0.001). In predicting ROSC, rSO2 levels ≥24% provided 100% sensitivity (95% confidence interval [CI] 92–100), and rSO2 levels ≥64% provided 100% specificity (95% CI 88–100). The area under the curve for ROSC prediction using rSO2 levels during CPR was 0.74 (95% CI 0.62–0.83). A relationship between ROSC and high rSO2 levels in witnessed cardiac arrests exists. Monitoring rSO2 levels during CPR would be useful in CPR management and ROSC prediction. During CPR, MCCD or manual chest compression has no distinct effect on oxygen delivery to the brain. Trial registration: clinicaltrials.gov identifier: NCT03238287.