Near-infrared spectroscopy monitoring during cardiac arrest: a systematic review and meta-analysis

Abstract

Background

Tissue oximetry using near-infrared spectroscopy (NIRS) is a non-invasive monitor of cerebral oxygenation. This new technology has been used during cardiac arrest (CA) because of its ability to give measures in low blood flow situations. The aim of this study was to assess the evidence regarding the association between the types of NIRS measurements (mean, initial and highest values) and resuscitation outcomes (return of spontaneous circulation (ROSC), survival to discharge and good neurologic outcome) in patients undergoing cardiopulmonary resuscitation.

Methods and results

This review was registered (Prospero CRD42015017380) and is reported as per the PRISMA guidelines.

Medline, Embase and CENTRAL were searched. All studies, except case reports and case series of fewer than five patients, reporting on adults that had NIRS monitoring during CA were eligible for inclusion. Two reviewers assessed the quality of the included articles and extracted the data. The outcome effect was standardized using standardized mean difference (SMD).

Twenty non-randomized observational studies (15 articles and five conference abstracts) were included in this review, for a total of 2436 patients. We found a stronger association between ROSC and mean NIRS values (SMD 1.33 [95% confidence interval (CI) 0.92-1.74]) than between ROSC and initial NIRS measurements (SMD 0.51 [95% CI 0.23-0.78]). There was too much heterogeneity amongst the highest NIRS measurements group to perform meta-analysis. Only two of the 75 patients who experienced ROSC had a mean NIRS saturation under 30%. Patients who survived to discharge and who had good neurologic outcome displayed superior combined initial and mean NIRS values than their counterparts (SMD 1.63 [95% CI 1.34-1.92]; SMD 2.12 [95% CI 1.14-3.10]).

Conclusions

Patients with good resuscitation outcomes have significantly higher NIRS saturations during resuscitation than their counterparts. The types of NIRS measurements during resuscitation influenced the association between ROSC and NIRS saturation. Prolonged failure to obtain a NIRS saturation higher than 30% may be included in a multi-modal approach to the decision of terminating resuscitation efforts (Class IIb, Level of Evidence C-Limited Data).

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