Near-infrared spectroscopy, pupillometry and end-tidal CO2 as predictive factors of survival at hospital admission after out-of-hospital cardiac arrest.
Resuscitation plus · 2026-04-09 · Observational study
Abstract
BACKGROUND: Early prognostication of out-hospital cardiac arrest (OHCA) patient's during cardiopulmonary resuscitation (CPR) is challenging and based on a combination of factors. The aim of this study was to assess the prognostic value of cerebral oximetry (rSO2), infrared automated pupillometry and end-tidal CO2 (EtCO2) alone or in combination for patients with OHCA. METHODS: A prospective multicenter cohort study in 3 French prehospital mobile intensive care units was performed. Adult patients with a presumed medical OHCA were included. Measurements were made at medical team arrival every 5 min for at least 15 min. The primary endpoint was the prognostic value of the parameters for survival at hospital admission. RESULTS: Of the 112 patients included and analyzed, 19 (17%) survived to hospital admission. Initial values for survival at hospital admission differed for rSO2 (alive: median: 30.0% (Q1: 19.0; Q3: 43.0) vs dead: 15.0% (15.0; 22.0), p < 0.001) and for EtCO2 (43.5 mmHg (26.8; 56) vs. 22.0 mmHg (15.0; 36.5), p = 0.006) in contrast to pupillometry values (6.0% (2.0; 11.5) vs. 3.0% (0; 7.5), p = 0.10). Initial rSO2 alone had an AUC of 0.74 (95% CI 0.59-0.88) and EtCO2 alone provide an AUC of 0.77 (95% CI 0.64-0.89). Pupillometry alone had an AUC of 0.65 (95% CI 0.51-0.79). In combination, initial EtCO2 plus initial rSO2 provided an AUC of 0.85 (95% CI 0.73-0.96). CONCLUSION: During OHCA, rSO2 and EtCO2 could be predictive factors for survival at hospital admission with an acceptable discrimination, and their prognostic value was improved when both factors were combined. Further studies are needed to clarify the prognostic value of rSO2, EtCO2 and pupillometry for survival at hospital admission.