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Introduction  By maintaining sufficient cerebral blood flow and oxygenation, the goal of cardiopulmonary resuscitation (CPR) is to preserve the pre-arrest neurological state. To date, cerebral monitoring abilities during CPR have been limited. Therefore, we investigated the time-course of cerebral oxygen saturation values (rSO 2 ) during advanced life support in out-of-hospital cardiac arrest. Our primary aim was to compare rSO 2  values during advanced life support from patients with return of spontaneous circulation (ROSC) to patients who did not achieve ROSC.    Methods  We performed an observational study to measure rSO 2  using Equanox™ (Nonin, Plymouth, MI) from the start of advanced life support in the pre-hospital setting.    Results  rSO 2  of 49 consecutive out-of-hospital cardiac arrest patients were analyzed. The total increase from initial rSO 2  value until two minutes before ROSC or end of advanced life support efforts was significantly larger in the group with ROSC 16% (9 to 36) compared to the patients without ROSC 10% (4 to 15) ( P  = 0.02). Mean rSO 2  from the start of measurement until two minutes before ROSC or until termination of advanced life support was higher in patients with ROSC than in those without, namely 39% ± 7 and 31% ± 4 ( P  = 0.05) respectively.    Conclusions  During pre-hospital advanced life support, higher increases in rSO 2  are observed in patients attaining ROSC, even before ROSC was clinically determined. Our findings suggest that rSO 2  could be used in the future to guide patient tailored treatment during cardiac arrest and could therefore be a surrogate marker of the systemic oxygenation state of the patient.

Increase in cerebral oxygenation during advanced life support in out-of-hospital patients is associated with return of spontaneous circulation