Cerebral Oximetry During Pediatric In-Hospital Cardiac Arrest: A Multicenter Study of Survival and Neurologic Outcome

Abstract

Objectives: To determine if near-infrared spectroscopy measuring cerebral regional oxygen saturation (crSo 2) during cardiopulmonary resuscitation is associated with return of spontaneous circulation (ROSC) and survival to hospital discharge (SHD) in children. Design: Multicenter, observational study. Setting: Three hospitals in the pediatric Resuscitation Quality (pediRES-Q) collaborative from 2015 to 2022. Patients: Children younger than 18 years, gestational age 37 weeks old or older with in-hospital cardiac arrest (IHCA) receiving cardiopulmonary resuscitation greater than or equal to 1 minute and intra-arrest crSo 2 monitoring. Interventions: None. Measurements and Main Results: Primary outcome was ROSC greater than or equal to 20 minutes without extracorporeal membrane oxygenation. Secondary outcomes included SHD and favorable neurologic outcome (FNO) (Pediatric Cerebral Performance Category 1–2 or no change from prearrest). Among 3212 IHCA events (index and nonindex), 123 met inclusion criteria in 93 patients. Median age was 0.3 years (0.1–1.4 yr) and 31% (38/123) of the cardiopulmonary resuscitation events occurred in patients with cyanotic heart disease. Median cardiopulmonary resuscitation duration was 8 minutes (3–28 min) and ROSC was achieved in 65% (80/123). For index events, SHD was achieved in 59% (54/91) and FNO in 41% (37/91). We determined the association of median intra-arrest crSo 2 and percent of crSo 2 values above a priori thresholds during the: 1) entire cardiopulmonary resuscitation event, 2) first 5 minutes, and 3) last 5 minutes with ROSC, SHD, and FNO. Higher crSo 2 for the entire cardiopulmonary resuscitation event, first 5 minutes, and last 5 minutes were associated with higher likelihood of ROSC, SHD, and FNO. In multivariable analysis of the infant group (age < 1 yr), higher crSo 2 was associated with ROSC (odds ratio [OR], 1.06; 95% CI, 1.03–1.10), SHD (OR, 1.04; 95% CI, 1.01–1.07), and FNO (OR, 1.05; 95% CI, 1.02–1.08) after adjusting for presence of cyanotic heart disease. Conclusions: Higher crSo 2 during pediatric IHCA was associated with increased rate of ROSC, SHD, and FNO. Intra-arrest crSo 2 may have a role as a real-time, noninvasive predictor of ROSC.