Relationship between cortical electrical responsiveness and changes in regional cerebral oxygenation (rSO) and return of spontaneous circulation in prolonged cardiac arrest: a multi-center observational study
Huppert, Elise L Roellke, Emma Anbarasan, Deepti Spiegel, Rebecca Tarpey, Thaddeus Abe, Olumayowa Bloom, Benjamin M Cairns, Charles Chan, Louisa Chawla, Shalinee
Huppert, Elise L
Roellke, Emma
Anbarasan, Deepti
Spiegel, Rebecca
Tarpey, Thaddeus
Abe, Olumayowa
Bloom, Benjamin M
Cairns, Charles
Chan, Louisa
Chawla, Shalinee
Abstract
Background: Ischemic/anoxic brain injury is often assumed to occur within minutes of severe cerebral ischemia. However, emerging evidence suggests brain tissue may be more resilient, with important implications for resuscitation. We hypothesized that during prolonged cardiac arrest, cortical electrical activity may be restorable if cerebral oxygenation thresholds are met and may be associated with return of spontaneous circulation (ROSC).
Methods: This was an ancillary cohort analysis of a multicenter, prospective observational study. Consecutive adult patients with in-hospital cardiac arrest were continuously monitored using electroencephalography (EEG) and near-infrared spectroscopy to assess regional cerebral oxygen saturation (rSO2) during cardiopulmonary resuscitation (CPR).
Results: Among 85 cardiac arrests (median duration 31 min, IQR 23-45), 53 yielded interpretable EEG recordings. Diffuse cortical suppression was the most common pattern (47%), but near-normal rhythms (40%: delta 22%, theta 12%, alpha 6%) and pathologic activity (13%) appeared above specific rSO2 thresholds. Delta and theta emerged at rSO2 ≥16%, and alpha at >40%. Alpha activity was seen up to 35 min, and delta/theta up to 60 min into CPR. Suppression reverted to near-normal in 12% of transitions. Alpha activity was associated with ROSC (OR 5.4; 95% CI 1.08-29.20; p = 0.045), while suppression predicted lower ROSC odds (OR 0.12; 95% CI 0.02-0.53; p = 0.002). Survival analysis was limited by small sample size.
Conclusion: Near-physiologic brain activity may be restored during prolonged CPR if oxygenation thresholds are met and is associated with ROSC. Further research is needed to evaluate survival outcomes.
MIDER Authors
Affiliations
New York University Grossman School of Medicine; Columbia University Irving Medical Center; Stony Brook University; NewYork-Presbyterian Queens Hospital; Barts Health NHS Trust; University of Arizona; Hampshire Hospitals NHS Foundation Trust; New York University Long Island School of Medicine; University Hospital Southampton NHS Foundation Trust; University of Iowa; University of Iowa Health Care; Virginia Tech Carilion School of Medicine; Kingston Hospital NHS Foundation Trust; St George's University Hospitals NHS Foundation Trust; University of Texas Southwestern Medical Center; The Ohio State University Wexner Medical Center; Hackensack University Medical Center; Augusta University Medical Center; West Hertfordshire Hospitals NHS Trust; University of Warwick; University Hospitals Birmingham NHS Foundation Trust; University of Texas Health San Antonio; University of California; University Hospitals Bristol NHS Foundation Trust; St. Anna University Hospital
Date
2026-02-25
Type
Article
Collections
Citation
Huppert EL, Roellke E, Anbarasan D, Spiegel R, Tarpey T, Abe O, Bloom BM, Cairns C, Chan L, Chawla S, Deakin CD, Findlay S, Foroozesh M, Girgis A, Gonzales-Silva A, Jarman H, Keshavarz-Shirazi T, Kulstad E, Lyaker M, Mengotto A, Ogedegbe C, O'Keeffe T, O'Neill C, Page V, Patel J, Perkins GD, Pradhan D, Scherer E, Sharma R, Sinha N, Tran L, Thomas M, Velchev V, Parnia S. Relationship between cortical electrical responsiveness and changes in regional cerebral oxygenation (rSO2) and return of spontaneous circulation in prolonged cardiac arrest: a multi-center observational study. Resuscitation. 2026 Apr;221:111031. doi: 10.1016/j.resuscitation.2026.111031. Epub 2026 Feb 25.