Associations Between Perfusion Index During Out-Of-Hospital Cardiopulmonary Resuscitation, Cardiopulmonary Resuscitation Quality and Return Of Spontaneous Circulation
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BACKGROUND
The association between perfusion index (PI) and out-of-hospital cardiac arrest survival outcomes is unknown. The American Heart Association suggested the need to improve the monitoring of cardiopulmonary resuscitation and chest compression quality. We hypothesized that higher event-average perfusion index values are associated with higher probability of return of spontaneous circulation, better survival and neurological outcomes.
METHODS
In this prospective cohort study of index out-of-hospital cardiac arrests attended from January 2022 through October 2024, we analyzed the association of the event-average perfusion index value with sustained return of spontaneous circulation. Secondary exposures included survival to hospital admission, favorable neurological outcome (Cerebral Performance Category ≤3 or no change from baseline) and associations between epoch-average PI and CPR quality metrics.
RESULTS
We included 98 index out-of-hospital cardiac arrests (mean [Standard Deviation]) age 62.1 years [17.6], 32% female, 9.2% shockable rhythm. Median event-average perfusion index was 0.29 ([Q1, Q3], 0.11, 0.92). Events with sustained return of spontaneous circulation had a higher event-level average perfusion index (0.92 [0.44, 1.73] mmol/L versus 0.19 [0.09, 0.55]; P <0.001). The receiver operating characteristic analyses of PI, as a predictor of sustained return of spontaneous circulation, identified an area under the curve of 0.77 [95% CI, 0.68– 0.86]) with an optimal cut point at 0.61 (sensitivity 0.67, specificity 0.81). After adjusting for confounders, PI was associated with higher relative risk of sustained ROSC (adjusted odds ratio, 2.6 [95% CI, 1.3–5.1]; P <0.001). Event-average PI was also associated with higher relative risk of survival to hospital admission (adjusted odds ratio, 2.1 [95% CI, 1.2–3.7]; P =0.001) while it was not associated with higher relative risk of neurological intact survival (adjusted odds ratio, 4.0 [95% CI, 0.8– 19.4]; P =0.085). Higher epoch-average PI was independently associated with higher chest compression fraction ( P =0.003).
CONCLUSIONS
Higher event-average PI was associated with higher probability of sustained return of spontaneous circulation. Event-average PI was associated with higher adjusted probability of return of spontaneous circulation, but not with neurological intact survival. Epoch-average PI was positively correlated with chest compression fraction.
