Paramedic CAT (Critically Appraised Topic)

011 | Cerebral Oximetry in OHCA 

Author	Jacob Hutton	Date	2020-08-20
Reviewer	-	Edited	2020-10-22

Case Study

After obtaining return of spontaneous circulation (ROSC) and transporting an adult patient who suffered an out-of-hospital cardiac arrest (OHCA) to the hospital, you wonder if there are any technological options for monitoring effectiveness of CPR and predicting ROSC in the pre-hospital setting.

PICO Question

“For patients in the pre-hospital setting who experience sudden cardiac arrest, does the use of cerebral oximetry provide actionable feedback on CPR quality and predict likelihood of ROSC?” 

Population	Adult patients in the pre-hospital setting who experience sudden cardiac arrest
Intervention	The use of a device monitoring cerebral oxygenation
Comparison	Standard CPR with no device
Outcome	Prediction of ROSC and evaluation of CPR quality

Search Strategy

PubMed: cerebral oximetry AND ("cardiac arrest" OR "CPR") AND ("EMS" OR "ambulance" OR "prehospital")

Search Outcome

11 Results (8 Relevant) on 2020-08-20

Clinical Bottom Line

While CPR best practices currently emphasize the importance of maintaining cerebral perfusion during cardiac arrest, many providers in the pre-hospital setting have few tools to actively monitor effectiveness of resuscitation in real-time. The use of cerebral oximetry devices in the prehospital setting has been shown to outperform end-tidal CO2 (ETCO2) in predicting ROSC. Patients who achieve ROSC exhibit a rapid and sustained rise in cerebral oxygenation, with normalization following ROSC. Persistently low levels of cerebral oxygenation have been shown to predict poor neurological outcomes.

The use of these devices may serve as a foundation for the next generation of CPR practices focused on neurological resuscitation, allowing prehospital providers to use real-time neuromonitoring to target cerebral perfusion. Small, compact devices are available and have been trialed in the ambulance setting with success. Cerebral oximetry also has the potential to be useful in prognostication and discontinuation of resuscitation and can be an effective tool in providing good data to increase quality of care. More research should be conducted on the economic and operational feasibility of its implementation at the ALS and BLS level.

References

1. Abramo T, Aggarwal N, Kane I, Crossman K, Meredith M. Cerebral oximetry and cerebral blood flow monitoring in 2 pediatric survivors with out-of-hospital cardiac arrest. 2014. [LINK]
2. Asim K, Gokhan E, Ozlem B, et al. Near infrared spectrophotometry (cerebral oximetry) in predicting the return of spontaneous circulation in out-of-hospital cardiac arrest. 2014. [LINK]
3. Engel TW 2nd, Thomas C, Medado P, et al. End tidal CO2 and cerebral oximetry for the prediction of return of spontaneous circulation during cardiopulmonary resuscitation. 2019. [LINK]
4. Genbrugge C, De Deyne C, Eertmans W, et al. Cerebral saturation in cardiac arrest patients measured with near-infrared technology during pre-hospital advanced life support. Results from Copernicus I cohort study. 2018. [LINK]
5. Genbrugge C, Dens J, Meex I, et al. Regional Cerebral Oximetry During Cardiopulmonary Resuscitation: Useful or Useless? 2016. [LINK]
6. Prosen G, Strnad M, Doniger SJ, et al. Cerebral tissue oximetry levels during prehospital management of cardiac arrest - A prospective observational study. 2018. [LINK]
7. Wik L. Near-infrared spectroscopy during cardiopulmonary resuscitation and after restoration of spontaneous circulation: a valid technology? 2016. [LINK]
8. Yagi T, Kawamorita T, Kuronuma K, et al. Usefulness of a New Device to Monitor Cerebral Blood Oxygenation Using NIRS During Cardiopulmonary Resuscitation in Patients with Cardiac Arrest: A Pilot Study. 2020. [LINK]