Comparison of manual and mechanical chest compression techniques using cerebral oximetry in witnessed cardiac arrests at the emergency department: A prospective, randomized clinical study

Aim: We aimed to compare regional cerebral oxygen saturation (rSO(2)) levels during cardiopulmonary resuscitation (CPR), performed either manually or using a mechanical chest compression device (MCCD), in witnessed cardiac arrest cases in the emergency department (ED), and to evaluate the effects of both the CPR methods and perfusion levels on patient survival and neurological outcomes. Methods: This single-center, randomized study recruited patients aged >= 18 years who had witnessed a cardiopulmonary arrest in the ED. According to the relevant guidelines, CPR was performed either manually or using an MCCD. Simultaneously, rSO(2) levels were continually measured with near-infrared spectroscopy. Results: Seventy-five cases were randomly distributed between the MCCD (n = 40) and manual CPR (n = 35) groups. No significant difference in mean rSO(2) levels was found between the MCCD and manual CPR groups (46.35 +/- 14.04 and 46.60 +/- 12.09, respectively; p = 0.541). However, a significant difference in rSO(2) levels was found between patients without return of spontaneous circulation (ROSC) and those with ROSC (40.35 +/- 10.05 and 50.50 +/- 13.44, respectively; p < 0.001). In predicting ROSC, rSO(2) levels >= 24% provided 100% sensitivity (95% confidence interval [CI] 92-100), and rSO(2) levels >= 64% provided 100% specificity (95% CI 88-100). The area under the curve for ROSC prediction using rSO(2) levels during CPR was 0.74 (95% CI 0.62-0.83). Conclusion: A relationship between ROSC and high rSO(2) levels in witnessed cardiac arrests exists. Monitoring rSO(2) levels during CPR would be useful in CPR management and ROSC prediction. During CPR, MCCD or manual chest compression has no distinct effect on oxygen delivery to the brain. (C) 2020 Elsevier Inc. All rights reserved.