Cerebral Oximetry: The New Brain Monitor for Cardiac Arrest?

Kristi L. Koenig, MD, FACEP, FIFEM

Regional brain oxygen saturation measured at hospital arrival predicted 90-day neurological outcome.

Can a noninvasive, real-time indicator of cerebral perfusion — regional brain oxygen saturation (rSO2) — predict neurological outcomes in patients undergoing cardiac-arrest resuscitation? To find out, investigators conducted a prospective study of 672 unresponsive adult patients with nontraumatic out-of-hospital cardiac arrest who had rSO2 measurements taken with a near-infrared spectrometer placed on the forehead within 3 minutes of arrival to emergency departments (EDs) at 13 hospitals in Japan.

Nearly three quarters of patients were pronounced dead in the ED (termination of resuscitation is not permitted in the field in Japan), 23% died after hospital admission, and 6% remained alive at 90 days.

Patients with good neurological outcomes at 90 days (29 patients) had significantly higher levels of rSO2 at hospital arrival than those with poor neurological outcomes (643 patients). The optimal rSO2 value to predict survival with good neurological outcomes was >42% (sensitivity, 0.79; specificity, 0.95; positive predictive value, 0.41). Three patients with low rSO2 (≤15%) survived with good neurological outcomes.

Citation(s):

Ito N et al. Noninvasive regional cerebral oxygen saturation for neurological prognostication of patients with out-of-hospital cardiac arrest: A prospective multicenter observational study. Resuscitation 2014 Mar 4; [e-pub ahead of print].