PMID- 31088512 OWN - NLM STAT- MEDLINE DCOM- 20191219 LR - 20200309 IS - 1466-609X (Electronic) IS - 1364-8535 (Print) IS - 1364-8535 (Linking) VI - 23 IP - 1 DP - 2019 May 14 TI - Near-infrared spectroscopy after out-of-hospital cardiac arrest. PG - 171 LID - 10.1186/s13054-019-2428-3 [doi] LID - 171 AB - BACKGROUND: Cerebral hypoperfusion may aggravate neurological damage after cardiac arrest. Near-infrared spectroscopy (NIRS) provides information on cerebral oxygenation but its relevance during post-resuscitation care is undefined. We investigated whether cerebral oxygen saturation (rSO(2)) measured with NIRS correlates with the serum concentration of neuron-specific enolase (NSE), a marker of neurological injury, and with clinical outcome in out-of-hospital cardiac arrest (OHCA) patients. METHODS: We performed a post hoc analysis of a randomised clinical trial (COMACARE, NCT02698917) comparing two different levels of carbon dioxide, oxygen and arterial pressure after resuscitation from OHCA with ventricular fibrillation as the initial rhythm. We measured rSO(2) in 118 OHCA patients with NIRS during the first 36 h of intensive care. We determined the NSE concentrations from serum samples at 48 h after cardiac arrest and assessed neurological outcome with the Cerebral Performance Category (CPC) scale at 6 months. We evaluated the association between rSO(2) and serum NSE concentrations and the association between rSO(2) and good (CPC 1-2) and poor (CPC 3-5) neurological outcome. RESULTS: The median (inter-quartile range (IQR)) NSE concentration at 48 h was 17.5 (13.4-25.0) mug/l in patients with good neurological outcome and 35.2 (22.6-95.8) mug/l in those with poor outcome, p < 0.001. We found no significant correlation between median rSO(2) and NSE at 48 h, r(s) = - 0.08, p = 0.392. The median (IQR) rSO(2) during the first 36 h of intensive care was 70.0% (63.5-77.0%) in patients with good outcome and 71.8% (63.3-74.0%) in patients with poor outcome, p = 0.943. There was no significant association between rSO(2) over time and neurological outcome. In a binary logistic regression model, rSO(2) was not a statistically significant predictor of good neurological outcome (odds ratio 0.99, 95% confidence interval 0.94-1.04, p = 0.635). CONCLUSIONS: We found no association between cerebral oxygenation measured with NIRS and NSE concentrations or outcome in patients resuscitated from OHCA. TRIAL REGISTRATION: ClinicalTrials.gov, NCT02698917 . Registered on 26 January 2016. FAU - Jakkula, Pekka AU - Jakkula P AUID- ORCID: 0000-0002-7858-1365 AD - Department of Anaesthesiology, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland. pekka.jakkula@me.com. FAU - Hastbacka, Johanna AU - Hastbacka J AD - Department of Anaesthesiology, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland. FAU - Reinikainen, Matti AU - Reinikainen M AD - Department of Anaesthesiology and Intensive Care, University of Eastern Finland and Kuopio University Hospital, Kuopio, Finland. FAU - Pettila, Ville AU - Pettila V AD - Department of Anaesthesiology, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland. FAU - Loisa, Pekka AU - Loisa P AD - Department of Intensive Care, Paijat-Hame Central Hospital, Lahti, Finland. FAU - Tiainen, Marjaana AU - Tiainen M AD - Department of Neurology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland. FAU - Wilkman, Erika AU - Wilkman E AD - Department of Anaesthesiology, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland. FAU - Bendel, Stepani AU - Bendel S AD - Department of Intensive Care, Kuopio University Hospital, Kuopio, Finland. FAU - Birkelund, Thomas AU - Birkelund T AD - Aarhus University Hospital, Aarhus, Denmark. FAU - Pulkkinen, Anni AU - Pulkkinen A AD - Department of Intensive Care, Central Finland Central Hospital, Jyvaskyla, Finland. FAU - Backlund, Minna AU - Backlund M AD - Department of Anaesthesiology, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland. FAU - Heino, Sirkku AU - Heino S AD - Department of Anaesthesiology and Intensive Care, North Karelia Central Hospital, Joensuu, Finland. FAU - Karlsson, Sari AU - Karlsson S AD - Department of Intensive Care, Tampere University Hospital, Tampere, Finland. FAU - Kopponen, Hiski AU - Kopponen H AD - Department of Anaesthesiology, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland. FAU - Skrifvars, Markus B AU - Skrifvars MB AD - Department of Emergency Medicine and Services, University of Helsinki and Helsinki University Hospital, Helsinki, Finland. LA - eng SI - ClinicalTrials.gov/NCT02698917 GR - -/Helsingin Yliopisto/International GR - -/Helsingin ja Uudenmaan Sairaanhoitopiiri/International GR - -/Stiftelsen Dorothea Olivia, Karl Walter och Jarl Walter Perklens Minne (FI)/International GR - -/Laerdal Foundation for Acute Medicine (NO)/International GR - -/Medicinska Understodsforeningen Liv och Halsa (FI)/International GR - -/Finska Lakaresallskapet (FI)/International GR - -/Suomen Anestesiologiyhdistys/International GR - -/Orionin Tutkimussaatio (FI)/International GR - -/Svenska Kulturfonden/International PT - Journal Article PT - Randomized Controlled Trial PT - Research Support, Non-U.S. Gov't DEP - 20190514 PL - England TA - Crit Care JT - Critical care (London, England) JID - 9801902 RN - 0 (Biomarkers) RN - 142M471B3J (Carbon Dioxide) RN - EC 4.2.1.11 (Phosphopyruvate Hydratase) RN - S88TT14065 (Oxygen) SB - IM MH - Adult MH - Aged MH - Arterial Pressure/physiology MH - Biomarkers/analysis MH - Carbon Dioxide/analysis MH - Cerebrum/*blood supply/physiopathology MH - Chi-Square Distribution MH - Female MH - Humans MH - Male MH - Middle Aged MH - Out-of-Hospital Cardiac Arrest/blood/*complications/physiopathology MH - Oxygen/analysis MH - Perfusion/*standards MH - Phosphopyruvate Hydratase/*analysis MH - Prognosis MH - Prospective Studies MH - Spectroscopy, Near-Infrared/*methods MH - Statistics, Nonparametric MH - Survival Analysis MH - Ventricular Fibrillation/blood/complications/physiopathology PMC - PMC6518726 OTO - NOTNLM OT - Cardiac arrest OT - Cerebral oxygenation OT - Hypoxic ischemic encephalopathy OT - Intensive care OT - Neuron-specific enolase (NSE) COIS- ETHICS APPROVAL AND CONSENT TO PARTICIPATE: The study protocol was approved by the research ethics committees of the Northern Savo Hospital District, Finland (decision No. 295/2015), and the Midtjylland region, Denmark (decision No. 1-10-72-163-16). In addition, the trial protocol was approved by the institutional review board at each site. A deferred consent to participate was obtained from the patients' next of kin. In addition, an informed consent was obtained from all patients who regained sufficient neurological function for independent decision-making (CPC 1-2) after the intervention period. CONSENT FOR PUBLICATION: Not applicable. COMPETING INTERESTS: The authors declare that they have no competing interests. PUBLISHER'S NOTE: Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. EDAT- 2019/05/16 06:00 MHDA- 2019/12/20 06:00 PMCR- 2019/05/14 CRDT- 2019/05/16 06:00 PHST- 2019/02/19 00:00 [received] PHST- 2019/04/09 00:00 [accepted] PHST- 2019/05/16 06:00 [entrez] PHST- 2019/05/16 06:00 [pubmed] PHST- 2019/12/20 06:00 [medline] PHST- 2019/05/14 00:00 [pmc-release] AID - 10.1186/s13054-019-2428-3 [pii] AID - 2428 [pii] AID - 10.1186/s13054-019-2428-3 [doi] PST - epublish SO - Crit Care. 2019 May 14;23(1):171. doi: 10.1186/s13054-019-2428-3.