Cerebral Oximetry as a Real‐Time Monitoring Tool to Assess Quality of In‐Hospital Cardiopulmonary Resuscitation and Post Cardiac Arrest Care

Abstract

BackgroundRegional cerebral oxygen saturation (rSO2) as assessed by near infrared frontal cerebral spectroscopy decreases in circulatory arrest and increases with high-quality cardiopulmonary resuscitation. We hypothesized that higher rSO2 during cardiopulmonary resuscitation and after return of spontaneous circulation (ROSC) would predict survival to discharge and neurological recovery.Methods and ResultsThis prospective case series included patients experiencing in-hospital cardiac arrest. Cerebral oximetry was recorded continuously from initiation of resuscitation until ROSC and up to 48 hours post-arrest. Relationships between oximetry data during these time periods and outcomes of resuscitation survival and survival to discharge were analyzed. The cohort included 27 patients. Nineteen (70.3%) achieved ROSC, and 8 (29.6%) survived to discharge. Median arrest duration was 20.8 minutes (range =8 to 74). There was a significant difference in rSO2 between resuscitation survivors and resuscitation nonsurvivors at initiation of the resuscitative efforts (35% versus 17.5%, P =0.03) and during resuscitation (36% versus 15%, P =0.0008). No significant association was observed between rSO2 at ROSC or during the post-arrest period and survival to discharge. Among patients who survived to discharge, there was no association between cerebral performance category and rSO2 at ROSC, during resuscitation, or post-arrest.ConclusionsHigher rSO2 levels at initiation of resuscitation and during resuscitation are associated with resuscitation survival and may reflect high-quality cardiopulmonary resuscitation. However, in this small series, rSO2 was not predictive of good neurological outcome. Larger studies are needed to determine whether this monitoring modality can be used to improve clinical outcomes.

Near-infrared spectroscopy during cardiopulmonary resuscitation and after restoration of spontaneous circulation

“…Ibrahim et al [41] in hospital study documented that there was a significant difference in rSO 2 between survivors compared with those who died at initiation of resuscitation (35 vs. 17.5%, P ¼ 0.03) and during resuscitation (36 vs. 15%, P ¼ 0.0008). Ibrahim et al did not find any difference in rSO 2 between survivors and nonsurvivors regarding ROSC or post arrest period values, and no association between cerebral performance category score and rSO 2 at ROSC, during resuscitation, or post arrest.…”

Parameters Influencing Brain Oxygen Measurement by Regional Oxygen Saturation in Postcardiac Arrest Patients with Targeted Temperature Management

“…In these studies of PCAS patients in the intensive care unit (ICU), rSO 2 was significantly lower in nonsurviving (Meex et al, 2013;Ahn et al, 2014) and poor neurological outcome patients (Storm et al, 2014) than in surviving or good neurological outcome patients. In contrast, Ibrahim et al (2015) reported that there was no difference between the rSO 2 of survivors and nonsurvivors in the ICU setting. Recently, Ihara et al (2019) showed that there was no difference in the rSO 2 value between severely brain-injured PCAS patients with abnormal amplitude-integrated electroencephalography (aEEG) and mildly brain-injured patients with continuous aEEG wave.…”

“…I n several studies, near-infrared spectroscopy (NIRS) has been used to measure regional cerebral oxygen saturation (rSO 2 ) in patients with postcardiac arrest syndrome (PCAS) to predict the outcome and analyze the brain's metabolic status (Meex et al, 2013;Ahn et al, 2014;Storm et al, 2014;Ibrahim et al, 2015). In these studies of PCAS patients in the intensive care unit (ICU), rSO 2 was significantly lower in nonsurviving (Meex et al, 2013;Ahn et al, 2014) and poor neurological outcome patients (Storm et al, 2014) than in surviving or good neurological outcome patients.…”

Cerebral Oximetry and Cardiopulmonary Resuscitation

“…The article by Ibrahim et al in this issue of JAHA describes how cerebral oximetry measured during cardiopulmonary resuscitation (CPR) is associated with restoration of pulses and survival . The authors consider whether this technology, which is portable, noninvasive, and easy to apply, could be used to guide resuscitation.…”