Abstract
Despite three decades of advancements in cardiopulmonary resuscitation (CPR) methods and post-resuscitation care, neurological prognosis remains poor among survivors of out-of-hospital cardiac arrest, and there are no reliable methods for predicting neurological outcomes in patients with cardiac arrest (CA). Adopting more effective methods of neurological monitoring may aid in improving neurological outcomes and optimizing therapeutic interventions for each patient. In the present review, we summarize the development, evolution, and potential application of near-infrared spectroscopy (NIRS) in adults with CA, highlighting the clinical relevance of NIRS brain monitoring as a predictive tool in both pre-hospital and in-hospital settings. Several clinical studies have reported an association between various NIRS oximetry measurements and CA outcomes, suggesting that NIRS monitoring can be integrated into standardized CPR protocols, which may improve outcomes among patients with CA. However, no studies have established acceptable regional cerebral oxygen saturation cut-off values for differentiating patient groups based on return of spontaneous circulation status and neurological outcomes. Furthermore, the point at which resuscitation efforts can be considered futile remains to be determined. Further large-scale randomized controlled trials are required to evaluate the impact of NIRS monitoring on survival and neurological recovery following CA.
Highlights
Out-of-hospital cardiac arrest (OHCA) remains a major public health challenge worldwide
Despite advances in treatment, such as routine application of targeted temperature management (TTM), neurological prognosis remains poor among survivors of OHCA (2), and there are no reliable methods for predicting neurological outcomes in patients with cardiac arrest (CA) and post-cardiac arrest syndrome (PCAS)
We developed a search strategy using the combination of keywords and Medical Subject Heading (MeSH) terms, which were “(Near-infrared spectroscopy [MeSH] OR OR) AND ((Heart arrest [MeSH]) OR OR prehospital)” for PubMed and Web of Science, and [“Near-infrared spectroscopy,” “cardiac arrest,” “regional saturation”] for Google Scholar
Summary
Out-of-hospital cardiac arrest (OHCA) remains a major public health challenge worldwide. Despite advances in treatment, such as routine application of targeted temperature management (TTM), neurological prognosis remains poor among survivors of OHCA (2), and there are no reliable methods for predicting neurological outcomes in patients with cardiac arrest (CA) and post-cardiac arrest syndrome (PCAS). Application of NIRS monitoring may aid in predicting patient outcomes, which may in turn aid clinicians in determining whether to continue or halt resuscitation efforts based on the patient’s chance of survival. Patients with low initial NIRS values may benefit from more aggressive resuscitation efforts (e.g., improved CPR, pharmacological treatment, circulatory support). The cut-off rSO2 value for predicting good vs poor clinical outcomes in patients with CA. Further studies are required to determine the predictive value of NIRS monitoring and its potential for guiding treatment strategies in patients with OHCA (25). We discuss the development and evolution of NIRS technology, as well as the potential usefulness of rSO2 during CA and post-resuscitation care
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