Effectiveness of near-infrared spectroscopy-guided continuous chest compression resuscitation without rhythm check in patients with out-of-hospital cardiac arrest: The prospective multicenter TripleCPR 16 study

• Published in: Resuscitation Vol. 169; pp. 146 - 153
• Main Authors: Takegawa, Ryosuke, Taniuchi, Satsuki, Ohnishi, Mitsuo, Muroya, Takashi, Hayakawa, Koichi, Tachino, Jotaro, Hirose, Tomoya, Nakao, Shunichiro, Muratsu, Arisa, Sakai, Tomohiko, Hayashida, Kei, Shintani, Ayumi, Becker, Lance B., Shimazu, Takeshi, Shiozaki, Tadahiko
• Format: Journal Article
• Language: English
• Published: Ireland Elsevier B.V 01.12.2021
• Subjects: Adult; Cardiopulmonary Resuscitation; Cerebral oximetry; Cerebrovascular Circulation; Continuous chest compression; Heart arrest; Humans; Near-infrared spectroscopy; Out-of-Hospital Cardiac Arrest - therapy; Oximetry; Oxygen Saturation; Prospective Studies; Regional cerebral oxygen saturation; Return of spontaneous circulation; Spectroscopy, Near-Infrared; Timing of rhythm check; CC; ECMO; Continuous chest compression; OR; Cerebral oximetry; CPR; CI; IPTW; EMS; ROSC; Near-infrared spectroscopy; Heart arrest; A-AD; rSO2; Regional cerebral oxygen saturation; CPA; Cardiopulmonary resuscitation; SAE; NIRS; Timing of rhythm check; DNAR; Return of spontaneous circulation; CA
• ISSN: 0300-9572; 1873-1570; 1873-1570
• DOI: 10.1016/j.resuscitation.2021.09.006

The proportion of adult patients with return of spontaneous circulation (ROSC) following out-of-hospital cardiac arrest (OHCA) remains unchanged since 2012. A better resuscitation strategy is needed. This study evaluated the effectiveness of a regional cerebral oxygen saturation (rSO2)-guided resuscitation protocol without rhythm check based on our previous study. Because defibrillation is the definitive therapy that should be performed without delay for shockable rhythm, the study subjects were OHCA patients with non-shockable rhythm on hospital arrival at three emergency departments. They were divided into three groups based on their baseline rSO2 value (%): ≥50, ≥40 to <50, or <40. Continuous chest compression without rhythm checks was performed for 16 minutes or until a maximum increase in rSO2 of 10%, 20%, or 35% was achieved in each group, respectively. This intervention cohort was compared with a historical control cohort regarding the probability of ROSC using inverse probability of treatment weighting (IPTW) with propensity score. The control and intervention cohorts respectively included 86 and 225 patients. The rate of ROSC was not significantly different between the groups (adjusted OR 0.91 [95% CI, 0.64–1.29], P = 0.60), but no serious adverse events occurred. Sensitivity analyses 1 and 2 showed a significant difference or positive tendency for higher probability of ROSC (adjusted OR 1.63 [95% CI, 1.22–2.17], P < 0.001) (adjusted OR 1.25 [95% CI, 0.95–1.63], P = 0.11). This trial suggested that a new cardiopulmonary resuscitation protocol with different rhythm check timing could be created using the rSO2 value. Clinical trial number: UMIN000025684.