Introduction:
Cerebral near-infrared spectroscopy (NIRS) measuring regional oxygen saturation (rSO
2
) during cardiopulmonary resuscitation (CPR) is associated with return of spontaneous circulation (ROSC) and survival to hospital discharge (SHD) in adults, with limited data in children. We hypothesized mean cerebral rSO
2
during pediatric in-hospital cardiac arrest (IHCA) would be associated with return of spontaneous circulation (ROSC).
Methods:
Consecutive case series of pediatric IHCA events with rSO
2
data reported between 2016-2020 by 3 sites to the Pediatric Resuscitation Quality (pediRES-Q) collaborative. We excluded patients with CPR duration ≤2 minutes or who had return of circulation via extracorporeal membrane oxygenation. We calculated mean rSO
2
for duration of CPR and the primary outcome measure was ROSC. Exploratory sensitivity analyses were performed for cutoffs of mean rSO
2
>25, >30, >35, >40 and >50%. Analysis was done using independent samples t test, Exact logistic regression and Fisher’s exact test.
Results:
Of 36 events (26 index), median age was 3 [IQR 1,7.8] months; 29 (80.5%) had congenital heart disease and 15 (41.7%) had single ventricle (SV) physiology. Median CPR duration was 7.5 [IQR 3.8, 32.2] minutes and 28/36 (77.8%) had ROSC. Mean intra-arrest cerebral rSO
2
was 44.2% (±19.5) for ROSC vs. 37.4% (±15) for non-ROSC group (
p
=0.267). Using Exact logistic regression, there was no association found between rSO
2
and ROSC, even after controlling for age, presence of congenital heart disease, and SV physiology. Using mean rSO
2
cutoffs >25, >30, >35, >40, and >50%, we found no significant association with ROSC. We found same result in the SV subgroup.
Conclusion:
In this small pediatric cohort of predominantly cardiac patients, there was no significant association between cerebral rSO
2
during pediatric cardiac arrest and ROSC, even after controlling for important confounders of age and SV physiology. More extensive studies using larger populations, and evaluating intra-arrest change in cerebral rSO
2
from baseline, are warranted to provide more insight into the possibilities of using rSO
2
to guide CPR.
MP56: Intraosseous versus intravenous access in pediatric out-of-hospital cardiac arrest: an examination of prehospital vascular access methods and survival rates