Cerebral oximetry and return of spontaneous circulation after cardiac arrest: a systematic review and meta-analysis

Sanfilippo, Filippo, Serena, Giovanni, Corredor, Carlos, Benedetto, Umberto, Maybauer, Marc O., Al-Subaie, Nawaf, Madden, Brendan, Oddo, Mauro and Cecconi, Maurizio (2015) Cerebral oximetry and return of spontaneous circulation after cardiac arrest: a systematic review and meta-analysis. Resuscitation, 94 67-72. doi:10.1016/j.resuscitation.2015.06.023


Author Sanfilippo, Filippo
Serena, Giovanni
Corredor, Carlos
Benedetto, Umberto
Maybauer, Marc O.
Al-Subaie, Nawaf
Madden, Brendan
Oddo, Mauro
Cecconi, Maurizio
Title Cerebral oximetry and return of spontaneous circulation after cardiac arrest: a systematic review and meta-analysis
Journal name Resuscitation   Check publisher's open access policy
ISSN 1873-1570
0300-9572
Publication date 2015-09-01
Sub-type Critical review of research, literature review, critical commentary
DOI 10.1016/j.resuscitation.2015.06.023
Open Access Status Not Open Access
Volume 94
Start page 67
End page 72
Total pages 6
Place of publication Shannon, Ireland
Publisher Elsevier Ireland
Language eng
Subject 2711 Emergency Medicine
2907 Emergency
2705 Cardiology and Cardiovascular Medicine
Abstract Aim: The prediction of return of spontaneous circulation (ROSC) during resuscitation of patients suffering of cardiac arrest (CA) is particularly challenging. Regional cerebral oxygen saturation (rSO2) monitoring through near-infrared spectrometry is feasible during CA and could provide guidance during resuscitation. Methods: We conducted a systematic review and meta-analysis on the value of rSO2 in predicting ROSC both after in-hospital (IH) or out-of-hospital (OH) CA. Our search included MEDLINE (PubMed) and EMBASE, from inception until April 4th, 2015. We included studies reporting values of rSO2 at the beginning of and/or during resuscitation, according to the achievement of ROSC. Results: A total of nine studies with 315 patients (119 achieving ROSC, 37.7%) were included in the meta-analysis. The majority of those patients had an OHCA (n=225, 71.5%; IHCA: n=90, 28.5%). There was a significant association between higher values of rSO2 and ROSC, both in the overall calculation (standardized mean difference, SMD -1.03; 95%CI -1.39,-0.67; p<0.001), and in the subgroups analyses (rSO2 at the beginning of resuscitation: SMD -0.79; 95%CI -1.29,-0.30; p=0.002; averaged rSO2 value during resuscitation: SMD -1.28; 95%CI -1.74,-0.83; p<0.001). Conclusions: Higher initial and average regional cerebral oxygen saturation values are both associated with greater chances of achieving ROSC in patients suffering of CA. A note of caution should be made in interpreting these results due to the small number of patients and the heterogeneity in study design: larger studies are needed to clinically validate cut-offs for guiding cardiopulmonary resuscitation.
Formatted abstract
Aim: The prediction of return of spontaneous circulation (ROSC) during resuscitation of patients suffering of cardiac arrest (CA) is particularly challenging. Regional cerebral oxygen saturation (rSO2) monitoring through near-infrared spectrometry is feasible during CA and could provide guidance during resuscitation.

Methods: We conducted a systematic review and meta-analysis on the value of rSO2 in predicting ROSC both after in-hospital (IH) or out-of-hospital (OH) CA. Our search included MEDLINE (PubMed) and EMBASE, from inception until April 4th, 2015. We included studies reporting values of rSO2 at the beginning of and/or during resuscitation, according to the achievement of ROSC.

Results: A total of nine studies with 315 patients (119 achieving ROSC, 37.7%) were included in the meta-analysis. The majority of those patients had an OHCA (n = 225, 71.5%; IHCA: n = 90, 28.5%). There was a significant association between higher values of rSO2 and ROSC, both in the overall calculation (standardized mean difference, SMD –1.03; 95%CI –1.39,–0.67; p < 0.001), and in the subgroups analyses (rSO2 at the beginning of resuscitation: SMD –0.79; 95%CI –1.29,–0.30; p = 0.002; averaged rSO2 value during resuscitation: SMD –1.28; 95%CI –1.74,–0.83; p < 0.001).

Conclusions: Higher initial and average regional cerebral oxygen saturation values are both associated with greater chances of achieving ROSC in patients suffering of CA. A note of caution should be made in interpreting these results due to the small number of patients and the heterogeneity in study design: larger studies are needed to clinically validate cut-offs for guiding cardiopulmonary resuscitation.
Keyword Advanced cardiac life support
Cardiopulmonary resuscitation
Near infrared spectrometry
Resuscitation order
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Critical review of research, literature review, critical commentary
Collections: Official 2016 Collection
School of Medicine Publications
 
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