Regional cerebral oxygen saturation in cardiac arrest survivors undergoing targeted temperature management 36 °C versus 33 °C: A randomized clinical trial

Abstract

Aim of study: To investigate whether regional cerebral oxygen saturation (rSO(2)) diers in out-of-hospital cardiac arrest (OHCA) survivors undergoing targeted temperature management (TTM) 36 degrees C versus 33 degrees C. Methods: A randomized clinical trial was conducted at intensive care units in two referral hospitals. Fifty-seven comatose OHCA survivors were randomized into either a 36 degrees C or 33 degrees C group. Patients were cooled and maintained at an oesophageal temperature of either 36 degrees C or 33 degrees C for 24 hours, rewarmed at a rate of 0.25 degrees C/hour, and maintained at <37.5 degrees C until 72 hours. During 72 hours of TTM, rSO(2) was continuously monitored on the left forehead using near-infrared spectroscopy (INVOS (TM) 5100C). The rSO(2) level at 72 hours was compared between the two groups. Next, serial rSO(2) levels for 72 hours were compared using mixed eects regression. The association between rSO(2) levels and 6-month neurological outcomes was also evaluated. Results: There were no significant dierences in the rSO(2) level at 72 hours between the 36 degrees C and 33 degrees C groups (p = 0.372). Furthermore, serial rSO(2) levels for 72 hours of TTM were not dierent between the two groups (p = 0.733). However, low rSO(2) levels, particularly at 24 hours of TTM, were significantly associated with poor 6-month neurological outcomes (odds ratio = 0.899, 95% confidence interval: 0.831-0.974). The area under the receiver operating characteristic curve of the rSO(2) level at 24 hours for poor neurological outcomes was 0.800. Conclusions: Regardless of target temperatures, low rSO(2) levels during TTM were significantly associated with poor 6-month neurological outcomes in OHCA survivors.