Near-Infrared Spectroscopy Assessments of Regional Cerebral Oxygen Saturation for the Prediction of Clinical Outcomes in Patients With Cardiac Arrest: A Review of Clinical Impact, Evolution, and Future Directions

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.

A Machine Learning Model for the Prognosis of Pulseless Electrical Activity during Out-of-Hospital Cardiac Arrest

“…In particular, the prognosis of ROSC during resuscitation (for all rhythms, not only PEA) is a very active field of research. New and established technologies such as capnography [ 23 , 45 ], cerebral oximetry [ 46 , 47 ], echocardiography [ 18 , 48 ], or point-of-care testing (blood gas analysis) [ 49 ] have been explored. A complete up-to-date review is available in [ 17 ].…”

Does cerebral near‐infrared spectroscopy (NIRS) help to predict futile cannulation in extracorporeal cardiopulmonary resuscitation (ECPR)?

“…Assessing the quality of ongoing CPR is difficult. This can be done with endtidal CO 2 -measurement, 14 oximetry 12 and clinical presentation. cNIRS provides additional information about the quality of the ongoing CCPR, 12 and is able to predict the likelihood of ROSC in CCPR.…”

“…This can be done with endtidal CO 2 -measurement, 14 oximetry 12 and clinical presentation. cNIRS provides additional information about the quality of the ongoing CCPR, 12 and is able to predict the likelihood of ROSC in CCPR. [10][11][12] cNIRS measurement in these studies was initiated when starting advanced cardiac life support (ACLS).…”

“…cNIRS is a mobile technique that is easy to apply nearly everywhere. cNIRS assesses cerebral blood flow and regional tissue oxygen saturation (rSO 2 ) non-invasively in real-time without the need for pulsatile blood flow, 12 thus mirroring brain perfusion and/or oxygen delivery of the ongoing CPR. [10][11][12] Specific limitations of cNIRS (e.g., temperature) are not reported in recent literature, 12 and data on cNIRS prior to ECPR and survival are lacking.…”

Monitoring and modifying brain oxygenation in patients at risk of hypoxic ischaemic brain injury after cardiac arrest

“…Further clinical research is needed to establish the role of static versus dynamic rSO2 values; the cut-off values for correlations to patient-centered outcomes, including during different interventions for hypoxic ischemic brain injury, notably TTM; and the minimal duration of monitoring. It is also important to address the variability in reported rSO2 signals across different NIRS monitors [27] and overall cerebral tissue oxygenation [28].…”