Associations between pulsed oxygen saturation during out-of-hospital cardiopulmonary resuscitation, cardiopulmonary resuscitation quality and return of spontaneous circulation

doi:10.1016/j.resuscitation.2026.111215

Cardiac arrest & resuscitation

Associations between pulsed oxygen saturation during out-of-hospital cardiopulmonary resuscitation, cardiopulmonary resuscitation quality and return of spontaneous circulation

ResuscitationPublished 23 Jul 2026Observational cohort study

Main finding · Sustained ROSCResultAdjusted odds ratio 1.05 95% CI 1.02–1.08

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Authors' conclusion

Higher event-average SpO2 was associated with higher probability of unadjusted and adjusted sustained ROSC but not with neurological intact survival. Cycle-average SpO2 was not associated with chest compressions quality metrics.

Study context

Population: Index out-of-hospital cardiac arrest (OHCA) eventsindex OHCA
Participants: 98 events

Exposure: Higher vs lower event-average SpO2 during out-of-hospital CPR
Outcome: Sustained ROSC by event-average SpO2 (average of all recorded values during the resuscitation event)

Main finding

Sustained ROSC

Adjusted odds ratio

1.05

95% CI 1.02–1.08

P < 0.001

By group

Sustained return-of-spontaneous-circulation (ROSC)

72.3

IQR 57.0–82.9

No sustained ROSC

48.0

IQR 34.9–65.4

SpO2

aOR 1.05 (95% CI 1.02–1.08); P < 0.001

As reported in the abstract

AUC of SpO2 as predictor of sustained ROSC: 0.77 [95% CI, 0.68-0.86]
Optimal cut point: 71.0
Sensitivity at cut point: 58
Specificity at cut point: 0.85

Observational data: associations, not effects.

Further findings

Survival to hospital admission

	← Lower odds ←→ Higher odds →	aOR (95% CI)	P value
Event-average SpO2	0.512	1.03 (1.01–1.05)	P = 0.005
	0.512Adjusted odds ratio (log scale)

Neurologically intact survival (Cerebral Performance Category <3 or no change from baseline)

	← Lower odds ←→ Higher odds →	aOR (95% CI)	P value
Event-average SpO2	0.512	1.00 (0.96–1.05)	P = 0.79
	0.512Adjusted odds ratio (log scale)

Event-average SpO2, all events

Median event-average SpO2 (Q1, Q3 38.8, 72.3): 55.0

Chest compression quality metrics vs cycle-average SpO2 (mean SpO2 per 2-min CPR cycle)

Higher cycle-average SpO2 not associated with better chest compression metrics

Original publication

Associations between pulsed oxygen saturation during out-of-hospital cardiopulmonary resuscitation, cardiopulmonary resuscitation quality and return of spontaneous circulation. Resuscitation. Published 23 July 2026. doi:10.1016/j.resuscitation.2026.111215

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