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

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 (rSO(2)) 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 rSO(2) 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 rSO(2) 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 rSO(2) 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 (rSO(2) at the beginning of resuscitation: SMD -0.79; 95%CI -1.29,-0.30; p = 0.002; averaged rSO(2) 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. (C) 2015 Elsevier Ireland Ltd. All rights reserved.