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Regional cerebral oxygen saturation to predict favorable outcome in extracorporeal cardiopulmonary resuscitation: a systematic review and meta-analysis

Published:January 09, 2023DOI:https://doi.org/10.1053/j.jvca.2023.01.007

      Abstract

      Objective

      This systematic review and meta-analysis aimed to investigate the role of regional cerebral oxygen saturation (rSO2) in predicting survival and neurological outcomes after extracorporeal cardiopulmonary resuscitation (ECPR).

      Design

      We performed a systematic review and meta-analysis of all available literature.

      Setting

      We searched relevant databases (Pubmed/Medline, Embase) for studies measuring pre-cannulation rSO2 in ECPR patients and reporting mortality and/or neurological outcomes.

      Participants

      We included both in-hospital and out-of-hospital cardiac arrest patients receiving ECPR. We identified three observational studies including 245 adult patients.

      Interventions

      We compared patients with a low pre-cannulation rSO2 (≤ 15% or 16%) versus patients with a high (>15% or 16%) pre-cannulation rSO2. In addition, we carried out subgroup analyses on out-of-hospital cardiac arrest (OHCA) patients.

      Measurements and Main Results

      A high pre-cannulation rSO2 was associated with a reduced risk of mortality in overall ECPR recipients (98/151 [64.9%] in the high rSO2 group vs 87/94 [92.5%] in the low rSO2 group, risk differences (RD) -0.30; 95% confidence interval (CI) [-0.47 to -0.14]) and in OHCA (78/121 [64.5%] vs 82/89 [92.1%], RD 0.30; 95% CI [-0.48 to -0.12]). A high pre-cannulation rSO2 was also associated with a significantly better neurological outcome in the overall population (42/151 [27.8%] vs 2/94 [2.12%], RD 0.22; 95% CI [0.13 to 0.31]) and in OHCA patients (33/121 [27.3%] vs 2/89 [2.25%] RD 0.21; 95% CI [0.11 to 0.30]).

      Conclusions

      A low rSO2 before starting ECPR could be a predictor of mortality and survival with poor neurological outcomes.

      Keywords

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