Cerebral Oximetry After Cardiac Arrest (COACA)

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Clinical outcome after sudden cardiac arrest is very unfavorable with mortality rates of more than 90% and permanent brain damage in more than 50% of survivors The critical endpoint of cardio pulmonary resuscitation (CPR) is to prevent death and morbidity by establishing and maintaining brain perfusion and oxygenation; however, there is currently no simple and reliable way to evaluate the adequacy of brain tissue perfusion in cardiac arrest patients.The goal of the phase II study Cerebral Oximetry after Cardiac Arrest (COACA) is to develop and validate non-invasive brain tissue oxygen saturation (SbtO2) as a simple and effective measure of brain perfusion and oxygenation during and after resuscitation from cardiac arrest. We hypothesize that SbtO2 monitoring may one day be routinely used to (1) evaluate the adequacy of chest compressions, (2) avoid brain tissue hypoxia induced by excessive hyperventilation or shivering, (3) serve as an endpoint for goal-directed hemodynamic (blood pressure) support, and (4) evaluate the potential for neurological recovery. In cardiac arrest patients admitted to Columbia University Medical Center measurement of cerebral oxygenation (SbtO2) will be performed using near-infrared-spectroscopy (EQUANOX rSO2 technology brain oximeter, applied to via adhesive leads to the temples bilaterally) during and 48 hours after CPR (or until death). Apart from other parameters in the acute phase (blood pressure, arterial oxygen saturation, end tidal CO2 and cardiac output), neurological outcome will be measured until 90 days after hospital admission.Successful completion of the research will hopefully establish that SbtO2 monitoring is feasible during and after CPR and is a valid predictor of neurological recovery. If confirmed, it is anticipated that SbtO2 monitors may one day be routinely incorporated into portable cardiac defibrillators. Thresholds for optimal SbtO2 will be established, and future multicenter studies will be designed to determine whether goal-directed post-resuscitation hemodynamic support targeted at maintaining optimal SbtO2 values in the ICU can improve neurological outcome.