Improving the neurological prognosis following OHCA using real-time evaluation of cerebral tissue oxygenation

Koyama, Yoshinori; Inoue, Yoshiaki; Hisago, Shuhei; Marushima, Aiki; Hagiya, Keiichi; Yamasaki, Yuichiro; Enomoto, Yuki; Shimojo, Nobutake; Kawano, Satoru; Mizutani, Taro

doi:10.1016/j.ajem.2017.11.029

Cited by 8 publications

(8 citation statements)

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“…5 It is widely used for monitoring cerebral tissue oxygenation during cardiac bypass surgery, 6 qualitatively assessing chest compressions during cardiopulmonary resuscitation, 7 and estimating neurological outcomes. 8 In dermatology, efforts to apply NIRS to blood flow evaluation during flap formation and prognosis of wound healing have been reported. 9,10 Previous studies have reported the use of NIRS for the diagnosis of necrotizing fasciitis.…”

Section: Introductionmentioning

confidence: 99%

Diagnosis of skin and soft tissue infections using near‐infrared spectroscopy

Maruhashi

Kumazawa

et al. 2021

Acute Medicine & Surgery

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Aim Skin and soft tissue infections are classified into cellulitis and necrotizing fasciitis, which are difficult to distinguish. Necrotizing fasciitis has a poor prognosis and requires immediate intensive care. The diagnostic gold standard is to incise the lesion to determine whether necrosis has reached the fascia. We aimed to show that these infections can be differentiated using near‐infrared spectroscopy. Methods We describe two cases in an observational study about the utility of near‐infrared spectroscopy. Case 1 involved a 77‐year‐old man with a chief complaint of pain, redness, and swelling in the right lower leg for 1 week. Computed tomography of his legs showed no gas formation. Case 2 involved an 82‐year‐old man. He visited another hospital because of pain, redness, and swelling in the right thigh. Based on the X‐ray examination, necrotizing fasciitis was suspected, and he was transferred to our hospital. Results In Case 1, the regional oxygen saturation value was lower on the lesion side (41%) than on the healthy side (55%). We confirmed the depth of invasion by incision, leading to a diagnosis of necrotizing fasciitis. In Case 2, the thigh’s regional oxygen saturation was higher on the affected side (76%) than on the healthy side (61%). An incision was made for diagnosis, but the fascia was not necrotized. Thus, we diagnosed cellulitis and provided conservative treatment using antibiotics. Conclusion Near‐infrared spectroscopy can be utilized to measure tissue blood flow, and it could be useful as a non‐invasive diagnostic tool for skin and soft tissue infections.

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Section: Introductionmentioning

confidence: 99%

Diagnosis of skin and soft tissue infections using near‐infrared spectroscopy

Maruhashi

Kumazawa

et al. 2021

Acute Medicine & Surgery

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“…3 ). Consequently, SnO 2 has been proposed as an indicator of the quality of CPR [ 9 ]. However, few studies have examined the utility of SnO 2 during CPR.…”

Section: Discussionmentioning

confidence: 99%

“…It has been suggested that cerebral tissue oxygen saturation in patients with ROSC increases during CPR, and exceeds that in patients without ROSC [ 3 – 8 ]. In addition, cerebral tissue oxygen saturation may indicate the quality of CPR [ 3 , 9 ]. Although physiological monitoring of CPR also includes end-tidal carbon dioxide (ETCO 2 ) level and arterial blood pressure [ 10 ], the measurement of cerebral tissue oxygen saturation is quick and easy to perform.…”

Section: Introductionmentioning

confidence: 99%

“…Pulse-wave cerebral tissue oxygen saturation (SnO 2 ) is a marker of cerebral tissue oxygen saturation that represents the change in the oxygenated hemoglobin concentration as a percentage of the change in the total hemoglobin concentration [ 9 ]. Although general cerebral tissue oxygen saturation, including the tissue oxygenation index (TOI), represents the oxygenation of mainly stagnated hemoglobin in the regional vessels [ 13 ], SnO 2 may reflect fluctuations in blood flow through all vessels in the regional tissue [ 9 ]. Because high quality CPR is important to achieve ROSC, SnO 2 may be useful for predicting ROSC since it is influenced by the fluctuations in systemic blood flow caused by CPR.…”

Section: Introductionmentioning

confidence: 99%

“…Because high quality CPR is important to achieve ROSC, SnO 2 may be useful for predicting ROSC since it is influenced by the fluctuations in systemic blood flow caused by CPR. Furthermore, it has been suggested that SnO 2 could be a useful indicator of the quality of CPR [ 9 ]. However, to the best of our knowledge, no study has investigated whether SnO 2 predicts ROSC.…”

Section: Introductionmentioning

confidence: 99%

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Prediction of return of spontaneous circulation during cardiopulmonary resuscitation by pulse-wave cerebral tissue oxygen saturation: a retrospective observational study

et al. 2022

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Background It is difficult to predict the return of spontaneous circulation (ROSC) during cardiopulmonary resuscitation (CPR). Cerebral tissue oxygen saturation during CPR, as measured by near-infrared spectroscopy (NIRS), is anticipated to predict ROSC. General markers of cerebral tissue oxygen saturation, such as the tissue oxygenation index (TOI), mainly reflect venous oxygenation, whereas pulse-wave cerebral tissue oxygen saturation (SnO2), which represents hemoglobin oxygenation in the pulse wave within the cerebral tissue, is an index of arterial and venous oxygenation. Thus, SnO2 may reflect arterial oxygenation to a greater degree than does TOI. Therefore, we conducted this study to verify our hypothesis that SnO2 measured during CPR can predict ROSC. Methods Cardiac arrest patients who presented at the Emergency Department of Yamagata University Hospital in Japan were included in this retrospective, observational study. SnO2 and TOI were simultaneously measured at the patient’s forehead using an NIRS tissue oxygenation monitor (NIRO 200-NX; Hamamatsu Photonics, Japan). We recorded the initial, mean, and maximum values during CPR. We plotted receiver operating characteristic curves and calculated the area under the curve (AUC) to predict ROSC. Results Forty-two patients were included. SnO2 was significantly greater in the ROSC group than in the non-ROSC group in terms of the initial (37.5% vs 24.2%, p = 0.015), mean (44.6% vs 10.8%, p < 0.001), and maximum (79.7% vs 58.4%, p < 0.001) values. Although the initial TOI was not significantly different between the two groups, the mean (45.1% vs 36.8%, p = 0.018) and maximum (71.0% vs 46.3%, p = 0.001) TOIs were greater in the ROSC group than in the non-ROSC group. The AUC was 0.822 for the mean SnO2 (95% confidence interval [CI]: 0.672–0.973; cut-off: 41.8%), 0.821 for the maximum SnO2 (95% CI: 0.682–0.960; cut-off: 70.8%), and 0.809 for the maximum TOI (95% CI: 0.667–0.951; cut-off: 49.3%). Conclusion SnO2 values measured during CPR, including immediately after arrival at the emergency department, were higher in the ROSC group than in the non-ROSC group.

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