Cerebral oximetry: a developing tool for monitoring cerebral oxygenation during cardiopulmonary resuscitation

Abstract

Despite improvements in cardiopulmonary resuscitation (CPR), survival and neurologic recovery after cardiac arrest remain very poor because of the impact of severe ischemia and subsequent reperfusion injury. As the likelihood of survival and favorable neurologic outcome decreases with increasing severity of ischemia during CPR, developing methods to measure the magnitude of ischemia during resuscitation, particularly cerebral ischemia, is critical for improving overall outcomes. Cerebral oximetry, which measures regional cerebral oxygen saturation (rSO 2 ) by near-infrared spectroscopy, has emerged as a potentially beneficial marker of cerebral ischemia during CPR. In numerous preclinical and clinical studies, higher rSO 2 during CPR has been associated with improved cardiac arrest survival and neurologic outcome. In this narrative review, we summarize the scientific rationale and validation of cerebral oximetry across populations and pathophysiologic states, discuss the evidence surrounding its use to predict return of spontaneous circulation, rearrest, and neurologic outcome, and provide suggestions for incorporation of cerebral oximetry into CPR practice.

Intraoperative application of regional cerebral oxygen saturation monitoring for geriatric patients in China: a survey

“…Cerebral oxygen saturation monitoring is a real-time and non-invasive method to maintain cerebral oxygen balance. It measures the relative proportions of arteriovenous blood and capillary blood components in the target area and takes the weighted average of the arteriovenous blood oxygen saturation in the local brain tissue to reflect the changes in the balance of oxygen supply and oxygen consumption in the brain ( 12 , 13 ). However, cerebral oximetry has not yet been widely used in operating rooms and intensive care units around the world ( 14 , 15 ).…”

Mechanical active compression-decompression versus standard mechanical cardiopulmonary resuscitation: A randomised haemodynamic out-of-hospital cardiac arrest study

“…This technology has since been further developed. Nowadays, most NIRS devices use different wavelengths within the NIR-spectrum and multiple light-emitters and sensors to capture a purer signal and to calculate a more precise value [136]. More expensive emitter-sensor probes can make use of mean photon travel distance via advanced "time-of-flight "calculations, as well as modulated light beam and frequency domain technologies, to provide even more precise and detailed information on the brain tissue oxygenation state of the patient [137,138].…”

Tidal volume measurements via transthoracic impedance waveform characteristics: The effect of age, body mass index and gender. A single centre interventional study

“…This technology has since been further developed. Nowadays, most NIRS devices use different wavelengths within the NIR-spectrum and multiple light-emitters and sensors to capture a purer signal and to calculate a more precise value [136]. More expensive emitter-sensor probes can make use of mean photon travel distance via advanced "time-of-flight "calculations, as well as modulated light beam and frequency domain technologies, to provide even more precise and detailed information on the brain tissue oxygenation state of the patient [137,138].…”