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resuscitation
systematic review
paramedic
evidence
patient care
pre-hospital
clinical skills

Cerebral oximetry monitoring in OHCA

02 December 2018
Features
02 December 2018
Volume 10 · Issue 12

Abstract

Background:

Cerebral oximetry allows non-invasive, real-time monitoring information of cerebral blood flow. It has recently been used to provide information about cerebral perfusion during resuscitation efforts in cases of cardiac arrest and may give an indication of neurological survival. Most of this information has been obtained during the hospital phase of treatment and little is known about cerebral flow in the prehospital phase.

Methods:

A systematic review was carried out, with the PubMed and EMBASE databases searched to identify clinical trials where cerebral oximetry monitoring was performed in the prehospital phase of out-of-hospital cardiac arrest. It aimed specifically to answer the following questions: is cerebral oximetry monitoring feasible in the prehospital environment? Can cerebral oximetry be used as a useful marker of the quality of cardiopulmonary resuscitation in the prehospital setting? Can cerebral oximetry be used to assist decisions around prognostication and futility for out-of-hospital cardiac arrest?

Results:

Five studies were identified for review. Feasibility was demonstrated in four of these. The usefulness of cerebral oximetry in monitoring cardiopulmonary resuscitation has not been well explored in out-of-hospital cardiac arrest. Similarly, data linking intra-arrest cerebral oximetry values and prognosis in out-of-hospital cardiac arrest is sparse.

Conclusions:

Cerebral oximetry is feasible in out-of-hospital cardiac arrest but its usefulness in guiding resuscitation attempts in this environment remains largely unknown.

CPR is attempted in approximately 30 000 people who experience an out-of-hospital cardiac arrest (OHCA) in England each year (Resuscitation Council UK (RCUK), 2017). OHCA is associated with poor outcomes. In the year 2015–2016, return of spontaneous circulation (ROSC) before arrival at hospital was achieved in 28% of patients in the UK but survival-to-hospital discharge was achieved in only 8% (National Audit Office (NAO) and NHS England (NHSE), 2017).

Early, high-quality CPR is associated with better outcomes (Meaney et al, 2013; NAO and NHSE, 2017). Perfusion monitoring during resuscitation gives an indication of the quality of CPR being performed (Meaney et al, 2013). End-tidal CO2 is used as an indicator of perfusion but reflects pulmonary rather than cerebral flow (Ahn et al, 2013).

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Resuscitation
Cardiac arrest
Paramedics
Prehospital
Out-of-hospital cardiac arrest (OHCA)
Cerebral oximetry