Life Support In Patients Research Articles

Utilizing extracorporeal life support in patients with cardiogenic shock related to acute myocardial infarction: a critical appraisal of the current evidence.

Utilizing extracorporeal life support in patients with cardiogenic shock related to acute myocardial infarction: a critical appraisal of the current evidence.

The Extracorporeal life support in patients with acute myocardial infarction complicated by cardiogenic shock (ECLS-Shock) trial in Perspective.

The Extracorporeal life support in patients with acute myocardial infarction complicated by cardiogenic shock (ECLS-Shock) trial in Perspective.

Survival Outcome in Critically Ill Patients Receiving Extracorporeal Membrane Oxygenation Support: Early Experience from a University Hospital in Thailand.

Objective Extracorporeal membrane oxygenation (ECMO) is a relatively new technology used for life support in patients with cardiopulmonary failure from various causes. The objective of this study is to review the first 5-year experience in adopting this technology in a teaching hospital in southern Thailand. Methods The data of ECMO-supported patients in Songklanagarind Hospital, from the years 2014 to 2018, were retrospectively reviewed. Data sources were from electronic medical records and the database of the perfusion service. Parameters in focus included prior conditions and indications of ECMO, type of ECMO and cannulation method, complications during and after the treatment, and discharge statuses. Results A total of 83 patients received ECMO life support during the 5-year period and the number of cases per year increased. The proportion of venovenous: venoarterial ECMO in our institute was 49:34 cases and there were three cases who used ECMO as a part of cardiopulmonary resuscitation. Moreover, there were 57 cases who used ECMO for cardiac failure and 26 cases were for respiratory causes, while premature withdrawal was decided in 26 cases (31.3%). Overall survival from ECMO was 35/83 cases (42.2%) and survival to discharge was 32/83 (38.6%). During therapy, ECMO could restore serum pH to the normal range in all cases. Furthermore, those who used ECMO for respiratory failure had significantly higher survival probability (57.7%) when compared to the cardiac counterpart (29.8%, p -value = 0.03). Patients with younger ages also had significantly better survival outcomes. The most common complications were cardiac (75 cases, 85.5%), followed by renal (45 cases, 54.2%), and hematologic systems (38 cases, 45.8%). In those who survived to discharge, average ECMO duration was 9.7 days. Conclusion Extracorporeal life support is a technology that bridges the patients with cardiopulmonary failure to their recovery or definitive surgery. Despite the high complication rate, survival can be expected, especially in respiratory failure cases and relatively young patients.

Feasibility of transbronchial lung cryobiopsy in patients with veno-venous extracorporeal membrane oxygenation support.

Veno-venous extracorporeal membrane oxygenation (VV-ECMO) is essential life support in patients with severe acute hypoxaemic respiratory failure. However, biopsies should be considered for some patients with unknown aetiology. This study aims to evaluate the feasibility of transbronchial lung cryobiopsy (TBLC) in such patients. All patients with acute hypoxaemic respiratory failure of unknown aetiology who underwent TBLC with VV-ECMO support were retrospectively reviewed. Patients' characteristics, ventilation settings, procedure parameters, complications, pathological diagnosis and survival were summarised and analysed. Eight female and five male patients with VV-ECMO support underwent TBLC. The median age was 58 (interquartile range (IQR) 38-67) years old. Concurrent diseases were present in 10 of the 13 patients, seven of which were immunosuppressed. The median time between biopsy and VV-ECMO establishment was 2.0 (IQR 0.5-6.5) days. No patient died from the procedure. Neither pneumothorax nor severe bleeding occurred in any of the patients. Five of the 13 patients experienced moderate bleeding, and all bleeding events were successfully controlled with prophylactic balloon blockers. Pathological diagnosis by TBLC was obtained in all patients, and the diagnosis of diffuse alveolar damage was made in nine of them. In patients with VV-ECMO support, the TBLC procedure is generally safe when standardised bleeding prophylaxis is in place. TBLC contributes to identifying underlying aetiologies in patients with acute hypoxaemic respiratory failure of unknown aetiology.

Ethical-Medicolegal Aspects of Installation and Removal of Ventilator in Life Support Efforts for Critical Patients during Covid-19 Pandemic

This study aims to analyze the procedures and considerations of medical and medicolegal aspects regarding the installation and removal of the use of ventilators in life support for patients during the COVID-19 pandemic. This study uses a normative juridical legal research method. The results showed that the ethical aspects regarding the installation and removal of the use of ventilators in the effort to support patients’ life during the COVID-19 pandemic were based on an agreement that was born by agreement (therapeutic agreement). The decision to stop or postpone life support therapy for medical treatment for patients is made by a team of doctors who treats patients after consulting a team of doctors appointed by the Medical Committee or the Ethics Committee based on Permenkes Number 37 of 2014. Meanwhile, the legal basis of procedures is in the process of making the installation decision and releasing the use of ventilators in critical patients during the COVID-19 pandemic, referring to the provisions of Permenkes No. 37/2014, Permenkes No. 290 of 2008, and Permenkes RI No. 290 of 2008 concerning the rejection of medical action, which patients and or their closest relatives can do. The legal basis refers to the medicolegal aspect in critical patients when installing and removing a ventilator. It is used as an indicator for determining whether to withdraw life support or withhold life support. Besides being adjusted to the validity of an agreement according to the Civil Code as stipulated in Article 1320, a doctor can initiate to understand a patient in the preparation and legal consequences of this agreement

The Juridical Impications Of Withdrawal Life-Support In Hospital in Indonesia

Withdrawal life-support is mainly categorized as part of euthanasia. When viewed from the aspect of criminal law in force in Indonesia, Indonesia does not permit active euthanasia by anyone (including doctors and medics). If the doctor ends the patient’s life by euthanasia is considered to violate criminal law. The study aimed to find out about life-support for patients with brainstem death in the hospital and to find out about the juridical implications of withdrawal life-support in cases of brain stem death. Based on the data discovered to be recorded, some conclusions that life support for brain stem death patients in the hospital is not needed because the element is futile. The juridical implications of withdrawal life-support in brain stem death patients in hospitals can be exempted from lawsuits if the doctor has implemented duties by medical ethics and acting in a medical professional manner, especially article 344 of The Criminal Code.

Seizure-like activity at the onset of emergency medical service-witnessed out-of-hospital cardiac arrest: An observational study

AimsEmergency medical service (EMS) may detect seizure-like activity in addition to agonal breathing in out-of-hospital cardiac arrest (OHCA). This study investigates the incidence and predictors of seizure-like activity in nontraumatic, EMS-witnessed OHCA and their association with clinical outcomes. MethodsThis prospective study explored EMS-recorded concomitant signs/symptoms that lead to the requirement of advanced life support in patients with nontraumatic, EMS-witnessed OHCA. Seizure-like activity includes abnormal/tonic movements and eyeball deviation. Sudden OHCA was defined by the absence of signs/symptoms of impending cardiac arrest at EMS contact or progressive circulatory/respiratory depressions after the EMS contact. Neurologically favorable outcomes were defined as the cerebral performance category score of 1 or 2 at discharge. ResultsFrom April 2012 to March 2020, 465 patients were studied. The incidence of seizure-like activity at cardiac arrest onset was 12.7% (59/465) in all patients with nontraumatic, EMS-witnessed OHCA. Seizure-like activity was common during shockable initial rhythm; in patients with “sudden” OHCA; and in patients who were younger, male, or had a presumed cardiac etiology. In a boosting tree, shockable initial rhythm, “sudden” OHCA, and presumed cardiac etiology were major factors that predicted the incidence of seizure-like activity. Multivariate logistic regression models including and excluding OHCA characteristics revealed that both seizure-like activity and agonal breathing recorded during EMS-witnessed OHCA were associated with favorable outcomes. ConclusionsSeizure-like activity is a major sign/symptom of the onset of “sudden” cardiac arrest of presumed cardiac etiology, particularly in patients with shockable initial rhythms. Such activity were significantly associated with neurologically favorable outcomes.

Extracorporeal life support in patients with acute myocardial infarction complicated by cardiogenic shock - Design and rationale of the ECLS-SHOCK trial

In acute myocardial infarction complicated by cardiogenic shock the use of mechanical circulatory support devices remains controversial and data from randomized clinical trials are very limited. Extracorporeal life support (ECLS) - venoarterial extracorporeal membrane oxygenation - provides the strongest hemodynamic support in addition to oxygenation. However, despite increasing use it has not yet been properly investigated in randomized trials. Therefore, a prospective randomized adequately powered clinical trial is warranted. The ECLS-SHOCK trial is a 420-patient controlled, international, multicenter, randomized, open-label trial. It is designed to compare whether treatment with ECLS in addition to early revascularization with percutaneous coronary intervention or alternatively coronary artery bypass grafting and optimal medical treatment is beneficial in comparison to no-ECLS in patients with severe infarct-related cardiogenic shock. Patients will be randomized in a 1:1 fashion to one of the two treatment arms. The primary efficacy endpoint of ECLS-SHOCK is 30-day mortality. Secondary outcome measures such as hemodynamic, laboratory, and clinical parameters will serve as surrogate endpoints for prognosis. Furthermore, a longer follow-up at 6 and 12 months will be performed including quality of life assessment. Safety endpoints include peripheral ischemic vascular complications, bleeding and stroke. The ECLS-SHOCK trial will address essential questions of efficacy and safety of ECLS in addition to early revascularization in acute myocardial infarction complicated by cardiogenic shock.

Aspectos bioéticos de la extubación paliativa dentro de los cuidados de fin de vida en el paciente no recuperable en la UCI

Palliative, compassionate or terminal extubation are terms that are being included more and more frequently in hospital institutions and particularly in intensive care units (ICU). JustificationThe limited number of ICU beds in the world, the oldest age of the population and greater survival in acute disease, make there are more and more situations in those that require end-of-life decisions; in patients unable to make decisions and different positions in front of the artificial vital supports installed. Problem statementICUs that have not used palliative extubation within their strategies for reorienting the therapeutic effort or that they are initiating the culture of palliative sedation and end-of-life care, face the need for a review comprehensive subject matter and generate reflections on extubation due to compassion in the ICU. MethodologyLiterature review and analysis from a bioethical perspective. Results and discussionTerminal extubation appears as a strategy to avoid prolonging unnecessarily life in non-recoverable patients and as a measure to alleviate the suffering, in cases where there is no benefit from continuing invasive ventilatory support. The COVID-19 pandemic also generates another series of tensions to include, since it is necessary to avoid prolong life support in patients with unrecoverable conditions and who are no longer they benefit from being in the ICU due to the futility of the therapies; but it is known that the removal of the orotracheal tube creates a risk of aerosols, which can lead to increased exposure for the health personnel of the SARS-CoV-2 virus.

Outcome of extracorporeal membrane oxygenation support in patients with liver cirrhosis: a nationwide population-based cohort study.

Extracorporeal membrane oxygenation (ECMO) is used for life support in patients with liver cirrhosis (LC). However, there have been no studies evaluating the outcome of ECMO support in patients with LC. Using Taiwan's National Health Insurance (NHI) database, we retrospectively evaluated patients with LC who received veno-venous or veno-arterial ECMO between 1 January 2000 and 31 December 2013. The outcomes included ECMO-related complications, in-hospital mortality, all-cause mortality and long-term outcomes in patients with and without LC. A total of 7003 patients who received ECMO, of whom 233 (3.3%) had LC, were eligible for analysis. The LC patients who received ECMO support had a significantly higher risk of in-hospital mortality than the non-LC group (76.4% vs 60.7%; odds ratio 1.97; 95% confidence interval 1.44-2.70). The LC group also had a higher risk of complications, including de novo dialysis and massive blood transfusion with >10 units of red blood cells. Patients ≥65 years of age, patients with respiratory disease, patients with hypoalbuminaemia and liver transplant patients had higher in-hospital and 1-year mortality. The mortality rates for patients with 2 or more risk factors were 90.3% and 95.8%, respectively. LC was associated with a higher incidence of all-cause mortality and liver-related outcomes during follow-up. Our findings raise questions regarding the utility of ECMO for LC patients, especially when >2 risk factors have been identified. ECMO support for LC patients should be used with caution and with careful patient selection.

Abstract 101: Effect of Extracorporeal Membrane Oxygenation for Accidental Hypothermia With Absent Vital Signs: A Nationwide Observational Study

Introduction: Patients with accidental hypothermia and absent vital signs are increasingly receiving venoarterial extracorporeal membrane oxygenation (VA-ECMO). However, there is limited knowledge on the efficacy of this advanced rewarming method. Despite the limited evidence, the resuscitation guidelines from the European Resuscitation Council and the American Heart Association both recommended the use of extracorporeal life support in patients with accidental hypothermia and absent vital signs. Hypothesis: We hypothesized that VA-ECMO is associated with lower in-hospital mortality compared with cardiopulmonary resuscitation (CPR) only in patients with accidental hypothermia and absent vital signs. Methods: Using the Japanese Diagnosis Procedure Combination inpatient database from July 2010 to March 2017, we identified patients diagnosed with accidental hypothermia (International Classification of Diseases Tenth Revision code T68) who received closed-chest cardiac massage in hospital on admission day. Patients who received VA-ECMO on admission day were allocated to the VA-ECMO group, and those who received CPR only were allocated to the conventional CPR group. The primary outcome was in-hospital mortality. The secondary outcome was alert consciousness for Japan Coma Scale status at discharge. Propensity score analyses were performed to compare the outcomes between the two groups. Results: We identified 1,624 eligible patients during the 81-month study period. Of these, 19% (314 of 1,624) received VA-ECMO on admission day. Crude in-hospital mortality was 65.3% (205 of 314) and 84.1% (1,102 of 1,310) in the VA-ECMO and conventional CPR groups, respectively. Propensity score-matching analyses demonstrated significantly lower in-hospital mortality (risk difference, –14.1%; 95% confidence interval, –21.9% to –6.3%) and higher proportion of alert consciousness at discharge (risk difference, 8.5%; 95% confidence interval, 2.1% to 15.0%) in the VA-ECMO group compared with the conventional CPR group. Conclusions: VA-ECMO was significantly associated with decreased in-hospital mortality and favorable neurologic outcome compared with conventional CPR in patients with accidental hypothermia and absent vital signs.

Outcomes of Coronary Artery Bypass Grafting after Extracorporeal Life Support in Patients with Cardiac Arrest or Cardiogenic Shock.

BackgroundExtracorporeal life support (ECLS) is used as a bridge to revascularization in high-risk patients with ischemic heart disease. We reviewed our experiences of coronary artery bypass grafting (CABG) after ECLS in patients with cardiac arrest or refractory cardiogenic shock.MethodsWe retrospectively reviewed 4,616 patients who underwent CABG at our institution between May 2006 and February 2017. We identified patients who underwent CABG following ECLS for cardiogenic shock or cardiac arrest. Twenty-three patients (0.5% of all CABG cases) were enrolled in the analysis. Their median age was 65 years (Q1–Q3, 58–77 years). Nine patients (39.1%) were diagnosed with ST-elevation myocardial infarction. Mechanical complications after acute myocardial infarction, including acute mitral regurgitation, left ventricular rupture, and ventricular septal defect, occurred in 9 patients (39.1%).ResultsThe median time from cardiopulmonary resuscitation to ECLS initiation was 25 minutes (Q1–Q3, 18.5–28.5 minutes). Conventional CABG was performed in 10 patients (43.5%) who underwent concomitant intracardiac procedures. Postoperative ECLS was required in 16 patients (69.5%). The rate of successful ECLS weaning was 91.3% (n=21). There were 6 early mortalities (26.1%).ConclusionCABG after ECLS was very rare in real-world circumstances. Although the early mortality rate was high, the risk of mortality may be acceptable under such devastating circumstances.

An Algorithmic Approach for and Special Characteristics of Veno-Venous Extracorporeal Life Support in Patients With Severe Asthma Attack: A Case Report and Review of the Literature

Little is known about the indicators and special characteristics of veno-venous extracorporeal life support (VV-ECLS) in patients with a severe asthma attack. We included a new case with near-fatal asthma (NFA) in a medical intensive care unit (MICU). Cases with severe asthma attack requiring VV-ECLS from 1980 to 2018 from the literature were added. The general information, laboratory examinations, treatments and outcomes were summarized. There were seventeen cases with severe asthma attack supported with VV-ELCS from the literature, including our case; six of them received extracorporeal CO2 removal (ECCO2R). The average age of the patients was 37 (±18) years, and only three had an underlying disease. Among the seventeen patients, most had a history of prior exacerbations and improper therapies before the current exacerbation, for which there were eleven (64.7%) and nine (52.9%) patients, respectively. As high as fourteen patients (82.4%) had a combination of complications related to asthma pre-ECLS. The most common complication was severe and refractory acidosis. Arterial blood gas analysis values and respiratory mechanics improved significantly post-ECLS. The average blood flow and gas flow of the patients receiving VV-ECLS were 2.3 (±1.2) L/min and 4.0 (±2.6) L/min, respectively. The mean duration of ECLS was 48 (35-96) hours. Complications related to ECLS occurred in 35.3% of the patients, among which hemorrhage was the high prevalence (23.5%). An algorithmic approach to VV-ECLS was described for a patient with a history of prior exacerbations and improper therapies that should be actively supported by ECLS once he becomes unresponsive to maximal therapies or presents with a combination of severe complications. Considering the short duration and the high risk of haemorrhage, anticoagulation without heparin might be a choice.

Use of argatroban for extracorporeal life support in patients with nonheparin-induced thrombocytopenia: Analysis of 10 consecutive patients.

Unfractionated heparin (UFH) is currently the standard anticoagulant used in extracorporeal life support (ECLS). However, severe thrombocytopenia occurs frequently during ECLS use and it may be difficult to determine whether this represents heparin-induced thrombocytopenia (HIT) or not. In this case, UFH cannot be continued. Because a confirmatory laboratory test requires time, argatroban is empirically used if HIT is suspected. However, many patients are not found to have HIT. In non-HIT patients, the effectiveness and safety of argatroban are unclear. Thus, we investigated whether argatroban was safe and useful in patients who were suspected of having HIT and were started on argatroban, but were ultimately found to have non-HIT.We retrospectively reviewed all patients on ECLS who received the anticoagulant argatroban as an alternative to UFH between January 2014 and July 2015. The pretest clinical score (4Ts) was calculated, and a score greater than 4 was considered an indication for argatroban. The target-activated clotting time or activated partial thromboplastin time was 1.5 times the patient's upper normal value. Of 191 patients on ECLS during the study period, 10 (5.2%) were treated with argatroban infusion.No patients were found to have antiplatelet factor 4/heparin antibodies. The average maintenance dose of argatroban was 0.1 μg/kg/min. Platelet counts increased significantly following argatroban administration (P = .02). There were no anticoagulation-related complications such as bleeding or thrombosis.Our results suggest that argatroban is a safe alternative to UFH for patients with non-HIT on ECLS. Argatroban may have a more significant platelet-preserving effect than UFH, regardless of whether HIT is present.

Effects of integrated chain trauma emergency nursing mode in patients with acute severe trauma

Objective To explore the effects of integrated chain trauma emergency nursing mode in patients with acute severe trauma. Methods From January 2013 to July 2017, we selected 154 patients with acute severe trauma of emergency department as subjects by convenience sampling. A total of 76 patients from January 2013 to December 2014 were in control group receiving routine emergency care. A total of 78 patients from January 2015 to July 2017 were in observation group being treated with the integrated chain trauma emergency nursing. We compared the first-aid time and family satisfaction of patients between two groups. Results The times of disease assessment, vital signs judgement, basic life support of patients in observation group were shorter than those in control group with significant differences (P<0.01) . The family satisfaction of patients of observation group was higher than that of control group with a significant difference (P<0.01) . Conclusions The application of integrated chain trauma emergency nursing mode can effectively reduce the first-aid time of patients with acute severe trauma and improve patients' family satisfaction. Key words: Wounds and injuries; Nursing care; Integrated; Chain process

Race is a Predictor of Withdrawal of Life Support in Patients with Intracerebral Hemorrhage

Introduction: Medical and socioeconomic factors may impact decisions to change the goals of care for patients with intracerebral hemorrhage (ICH) to comfort measures only. Methods: We reviewed prospectively collected data on patients with ICH, including baseline patient demographics, Glasgow Coma Scale (GCS), National Institute of Health Stroke Scale (NIHSS), and ICH score. We conducted multivariable logistic regression analysis to identify predictors of change to comfort measures only status. Results: Of 198 patients included in the analysis, 39 (19.7%) were made comfort measures only. Age, gender, insurance status, substance use, and medical comorbidities were similar between groups. Race was significantly different between the comfort measures only (black 15.4%, white 51.3%, other 33.3%) and noncomfort measures only groups (black 39.6%, white 45.9%, other 14.5%; P = .003). Patients changed to comfort measures only had higher mean income based on zip code ($59,264 versus $49,916; P = .021), higher median NIHSS (23 versus 16; P = .0001), higher ICH score (2.7 versus 1.5; P < .0001), lower median GCS (7 versus 13; P < .0001). Following multivariable analysis, factors associated with comfort measures only were GCS odds ratio (OR) 0.77, 95% confidence interval (CI) 0.68-0.86, P < .0001), intraventricular hemorrhage (IVH) volume (OR 1.03, 95% CI 1.01-1.06, P = .002), and black race (OR 0.24, 95% CI 0.07-0.82, P = .022). Mortality, poor outcome, and hospital length of stay were not significantly different between black and white patients. Conclusions: Lower GCS score, higher IVH volume, and race were independent predictors of comfort measures only. Black patients were 76% less likely to withdraw life support than white patients. There were no significant differences in mortality between black and white patients. Providers should be aware of potential racial disparities.

COPD is independently associated with 6-month survival in patients who have life support withheld in intensive care.

In-hospital outcomes following decisions of withholding or withdrawing in Intensive Care Unit (ICU) patients have been previously assessed, little is known about outcomes after ICU and hospital discharge. Our objective was to report the 6-month outcomes of discharged patients who had treatment limitations in a general ICU and to identify prognostic factors of survival. We retrospectively collected the data of patients discharged from the ICU for whom life support was withheld from 2009 to 2011. We assessed the survival status of all patients at 6 months post-discharge and their duration of survival. Survivors and non-survivors were compared using univariate and multivariate analyses by Cox's proportional hazard model. One hundred fourteen patients were included. The survival rate at 6 months was 58.8%. Survival was associated with acute respiratory failure (48% vs 19%, P = .006), a history of COPD (40% vs 21%, P = .03) and a lower SAPS II score (44 vs 49, P = .006). We identified a history of COPD as a prognostic factor for survival in the multivariate analysis (HR = 2.1; IC 95% 1.02-4.36, P = .04). A total of 58.8% of patients for whom life-sustaining therapies were withheld in the ICU survived for at least 6 months after discharge. Patients with COPD appeared to have a significantly higher survival rate. The decision to withhold life support in patients should not lead to a cessation of post-ICU care and to non-readmission of COPD patients.

Extracorporeal Life Support in Patients with Primary Cardiogenic Shock: Predictors of Recovery and Survival

Refractory Cardiogenic Shock (RCS) is a life-threatening condition that requires emergent mechanical circulatory support (MCS) implantation. Extracorporeal Life Support (ECLS) can be considered the “bridge to life” device to keep the patient alive while the optimal therapeutic strategy is determined. We evaluated recovery and survival predictors in a single-centre experience.

Venovenous extracorporeal life support in patients with HIV infection and Pneumocystis jirovecii pneumonia.

As experience with extracorporeal life support (ECLS) increases, indications for its use have expanded to diverse patient populations, including those with HIV infection. Pneumocystis jirovecii pneumonia (PJP) is a particularly devastating complication of HIV infections. The objective of this study was to review ECLS use in HIV-positive patients, with particular emphasis on those with concomitant PJP infection. All patients were treated by the same ECLS team, consisting of an ECLS specialist intensivist, cardiothoracic surgeon and allied medical professionals at three healthcare institutions. The same ECLS protocol was utilized for all patients during the study period. A retrospective review was performed for all HIV-positive patients placed on ECLS from May 2011 to October 2014. Demographic, clinical, ECLS and complication data were reviewed to identify risk factors for death. A total of 22 HIV-positive patients received ECLS therapy during the study period. All patients were supported with venovenous ECLS and overall survival to hospital discharge was 68%. Survival amongst the PJP positive cohort was 60%. Non-survivors were more likely to require inotropic medications on ECLS (100% non-survivors vs. 46.7% survivors, p=0.022) and had a longer total duration of ECLS (13 days non-survivors vs. 7 days survivors, p=0.011). No difference was observed between PJP-positive and PJP-negative patients with regard to demographic data, complication rates or survival. ECLS is a viable treatment option in carefully selected HIV-positive patients, including those with severe disease as manifested by PJP infection.

Comprehensive pre- and in-hospital near-infrared-spectroscopy can predict outcome parameters in patients after out-of-hospital cardiac arrest – A feasibility study

Background: The increase of regional brain oxygen saturation (rSO2) levels measured with Near-infrared-Spectroscopy during advanced life support in patients with out-of hospital cardiac arrest (OHCA) is associated with a higher likelihood of Return of Spontaneous Circulation (ROSC) and can predict neurological outcome.