Non-invasive diffuse optical neuromonitoring during cardiopulmonary resuscitation predicts return of spontaneous circulation

Abstract

Neurologic injury is a leading cause of morbidity and mortality following pediatric cardiac arrest. In this study, we assess the feasibility of quantitative, non-invasive, frequency-domain diffuse optical spectroscopy (FD-DOS) neuromonitoring during cardiopulmonary resuscitation (CPR), and its predictive utility for return of spontaneous circulation (ROSC) in an established pediatric swine model of cardiac arrest. Cerebral tissue optical properties, oxy- and deoxy-hemoglobin concentration ([HbO2], [Hb]), oxygen saturation (StO2) and total hemoglobin concentration (THC) were measured by a FD-DOS probe placed on the forehead in 1-month-old swine (8–11 kg; n = 52) during seven minutes of asphyxiation followed by twenty minutes of CPR. ROSC prediction and time-dependent performance of prediction throughout early CPR (< 10 min), were assessed by the weighted Youden index (Jw, w = 0.1) with tenfold cross-validation. FD-DOS CPR data was successfully acquired in 48/52 animals; 37/48 achieved ROSC. Changes in scattering coefficient (785 nm), [HbO2], StO2 and THC from baseline were significantly different in ROSC versus No-ROSC subjects (p < 0.01) after 10 min of CPR. Change in [HbO2] of + 1.3 µmol/L from 1-min of CPR achieved the highest weighted Youden index (0.96) for ROSC prediction. We demonstrate feasibility of quantitative, non-invasive FD-DOS neuromonitoring, and stable, specific, early ROSC prediction from the third minute of CPR.

Optical imaging and spectroscopy for the study of the human brain: status report

“…Another promising application for emergent monitoring is in clinical guidance during and after cardiopulmonary resuscitation (CPR). Several studies have demonstrated that optical brain monitoring during CPR is feasible, 400 – 405 and recent work suggests that brain-based CPR optimization promises to enhance neurologic outcomes. In a swine model, successful resuscitation was predicted by FD-NIRS neuromonitoring.…”

“…In a swine model, successful resuscitation was predicted by FD-NIRS neuromonitoring. 405 Encouraging associations between NIRS measures and outcomes have also been observed. [400][401][402][403] After arrest, pilot studies have explored using NIRS to individualize blood pressure targets 406,407 as well as the use of DCS measures of CBF low-frequency power 408 and pulsatility as a neurologic biomarker.…”

Advanced Neuromonitoring Modalities on the Horizon: Detection and Management of Acute Brain Injury in Children

“…Longitudinal neurometabolic optical monitoring has elucidated risk factors for hypoxic–ischemic brain injury in several pediatric contexts, including during birth transition in healthy and high-risk neonates [ 220 , 234 – 240 ], and during generalized seizures [ 241 , 242 ], cardiac surgery requiring cardiopulmonary bypass [ 213 , 225 , 243 , 244 ], and extracorporeal membrane oxygenation support [ 226 , 245 ]. Quantification of oxygen delivery to the brain intra-arrest [ 246 ] (Fig. 8 ) and low-frequency blood flow oscillations post arrest [ 247 ] may provide novel noninvasive targets for physiologic optimization of resuscitation and postarrest care.…”

“…The receiver operating characteristic curve for Δ[HbO 2 ] CPR prediction of ROSC has an area under the receiver operating characteristic curve (AUC) of 0.82 (0.1) in third minute of CPR and increases to 0.97 (0.04) in the tenth minute of CPR. (Adapted from Ko et al [ 246 ] under Creative Commons CC BY license: http://creativecommons.org/licenses/by/4.0/ .) …”

Latest in Resuscitation Research: Highlights From the 2021 American Heart Association's Resuscitation Science Symposium

“… 24 Maternal cardiac arrest requires an understanding of physiological changes during pregnancy and a modified ACLS algorithm to account for the management of 2 patients. Dr Todd Kilbaugh (University of Pennsylvania) presented on mitochondrial function in mediating neurologic outcomes in post–cardiac arrest animal models, 25 , 26 neurometabolic optical monitoring devices for cerebral metabolism, 27 and advanced approaches to neuroimaging and biomarkers for prognostication after neurologic insult. Focusing on postarrest neuroprognostication, Dr Hirsch (Stanford University) described how withdrawal of life‐sustaining treatment represents the majority of avoidable deaths because of perceptions of poor prognosis.…”