title: Cerebral oximetry and return of spontaneous circulation after cardiac arrest: A systematic review and meta-analysis.
abstract: OBJECTIVE
  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.
authors.affiliation: Cardiothoracic Intensive Care Unit, Intensive Care Directorate - St. Georges Healthcare NHS Trust, London SW17 0QT, United Kingdom. Electronic address: filipposanfi@yahoo.it.
authors.forename: Filippo
authors.initials: F
authors.lastname: Sanfilippo
authors.affiliation: Cardiothoracic Intensive Care Unit, Intensive Care Directorate - St. Georges Healthcare NHS Trust, London SW17 0QT, United Kingdom.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Serena
authors.affiliation: Cardiothoracic Intensive Care Unit, Intensive Care Directorate - St. Georges Healthcare NHS Trust, London SW17 0QT, United Kingdom.
authors.forename: Carlos
authors.initials: C
authors.lastname: Corredor
authors.affiliation: Department of Cardiothoracic Surgery, Oxford Heart Centre, Oxford University Hospitals, Oxford OX3 9DU, United Kingdom.
authors.forename: Umberto
authors.initials: U
authors.lastname: Benedetto
authors.affiliation: Critical Care Research Group, University of Queensland and the Prince Charles Hospital, Rode Road, Chermside, Brisbane, QLD 4032, Australia.
authors.forename: Marc O
authors.initials: MO
authors.lastname: Maybauer
authors.affiliation: Cardiothoracic Intensive Care Unit, Intensive Care Directorate - St. Georges Healthcare NHS Trust, London SW17 0QT, United Kingdom.
authors.forename: Nawaf
authors.initials: N
authors.lastname: Al-Subaie
authors.affiliation: Cardiothoracic Intensive Care Unit, Intensive Care Directorate - St. Georges Healthcare NHS Trust, London SW17 0QT, United Kingdom.
authors.forename: Brendan
authors.initials: B
authors.lastname: Madden
authors.affiliation: Department of Intensive Care Medicine, CHUV-Lausanne University Medical Center, CH-1011 Lausanne, Switzerland.
authors.forename: Mauro
authors.initials: M
authors.lastname: Oddo
authors.affiliation: Anaesthesia and Critical Care St. George's Hospital and Medical School, London SW17 0QT, United Kingdom.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Cecconi
mesh_terms: D016887:Cardiopulmonary Resuscitation / Q000379:methods*; D002560:Cerebrovascular Circulation / Q000502:physiology*; D006801:Humans; D058687:Out-of-Hospital Cardiac Arrest / Q000378:metabolism / Q000503:physiopathology / Q000628:therapy*; D010092:Oximetry / Q000379:methods*; D020127:Recovery of Function / Q000502:physiology*
keywords: Advanced cardiac life support; Cardiopulmonary resuscitation; Near infrared spectrometry; Resuscitation order