title: What is the value of regional cerebral saturation in post-cardiac arrest patients? A prospective observational study.
abstract: BACKGROUND
  The aim of this study was to elucidate the possible role of cerebral saturation monitoring in the post-cardiac arrest setting.
  
  
  METHODS
  Cerebral tissue saturation (SctO2) was measured in 107 successfully resuscitated out-of-hospital cardiac arrest patients for 48 hours between 2011 and 2015. All patients were treated with targeted temperature management, 24 hours at 33 °C and rewarming at 0.3 °C per hour. A threshold analysis was performed as well as a linear mixed models analysis for continuous SctO2data to compare the relation between SctO2and favorable (cerebral performance category (CPC) 1-2) and unfavorable outcome (CPC 3-4-5) at 180 days post-cardiac arrest in OHCA patients.
  
  
  RESULTS
  Of the 107 patients, 50 (47 %) had a favorable neurological outcome at 180 days post-cardiac arrest. Mean SctO2over 48 hours was 68 % ± 4 in patients with a favorable outcome compared to 66 % ± 5 for patients with an unfavorable outcome (p = 0.035). No reliable SctO2threshold was able to predict favorable neurological outcome. A significant different course of SctO2was observed, represented by a logarithmic and linear course of SctO2in patients with favorable outcome and unfavorable outcome, respectively (p < 0.001). During the rewarming phase, significant higher SctO2values were observed in patients with a favorable neurological outcome (p = 0.046).
  
  
  CONCLUSIONS
  This study represents the largest post-resuscitation cohort evaluated using NIRS technology, including a sizeable cohort of balloon-assisted patients. Although a significant difference was observed in the overall course of SctO2between OHCA patients with a favorable and unfavorable outcome, the margin was too small to likely represent functional outcome differentiation based on SctO2alone. As such, these results given such methodology as performed in this study suggest that NIRS is insufficient by itself to serve in outcome prognostication, but there may remain benefit when incorporated into a multi-neuromonitoring bedside assessment algorithm.
authors.affiliation: Faculty of Medicine and Life Sciences, Hasselt University, Martelarenlaan 42, 3500, Hasselt, Belgium. Cornelia.genbrugge@uhasselt.be.|Department of Anesthesiology, Intensive Care, Emergency Medicine and Pain Therapy, Ziekenhuis Oost-Limburg Genk, Schiepse Bos 6, 3600, Genk, Belgium. Cornelia.genbrugge@uhasselt.be.
authors.forename: Cornelia
authors.identifier: http://orcid.org/0000-0002-2558-8993
authors.initials: C
authors.lastname: Genbrugge
authors.affiliation: Faculty of Medicine and Life Sciences, Hasselt University, Martelarenlaan 42, 3500, Hasselt, Belgium.|Department of Anesthesiology, Intensive Care, Emergency Medicine and Pain Therapy, Ziekenhuis Oost-Limburg Genk, Schiepse Bos 6, 3600, Genk, Belgium.
authors.forename: Ward
authors.initials: W
authors.lastname: Eertmans
authors.affiliation: Department of Anesthesiology, Intensive Care, Emergency Medicine and Pain Therapy, Ziekenhuis Oost-Limburg Genk, Schiepse Bos 6, 3600, Genk, Belgium.
authors.forename: Ingrid
authors.initials: I
authors.lastname: Meex
authors.affiliation: Faculty of Medicine and Life Sciences, Hasselt University, Martelarenlaan 42, 3500, Hasselt, Belgium.|Department of Anesthesiology, Intensive Care, Emergency Medicine and Pain Therapy, Ziekenhuis Oost-Limburg Genk, Schiepse Bos 6, 3600, Genk, Belgium.
authors.forename: Margaretha
authors.initials: M
authors.lastname: Van Kerrebroeck
authors.affiliation: Faculty of Medicine and Life Sciences, Hasselt University, Martelarenlaan 42, 3500, Hasselt, Belgium.|Department of Anesthesiology, Intensive Care, Emergency Medicine and Pain Therapy, Ziekenhuis Oost-Limburg Genk, Schiepse Bos 6, 3600, Genk, Belgium.
authors.forename: Noami
authors.initials: N
authors.lastname: Daems
authors.affiliation: I-Biostat (CenStat), Hasselt University, Agoralaan gebouw D, 3590, Diepenbeek, Belgium.
authors.forename: An
authors.initials: A
authors.lastname: Creemers
authors.affiliation: Faculty of Medicine and Life Sciences, Hasselt University, Martelarenlaan 42, 3500, Hasselt, Belgium.|Department of Anesthesiology, Intensive Care, Emergency Medicine and Pain Therapy, Ziekenhuis Oost-Limburg Genk, Schiepse Bos 6, 3600, Genk, Belgium.
authors.forename: Frank
authors.initials: F
authors.lastname: Jans
authors.affiliation: Department of Anesthesiology, Intensive Care, Emergency Medicine and Pain Therapy, Ziekenhuis Oost-Limburg Genk, Schiepse Bos 6, 3600, Genk, Belgium.
authors.forename: Willem
authors.initials: W
authors.lastname: Boer
authors.affiliation: Faculty of Medicine and Life Sciences, Hasselt University, Martelarenlaan 42, 3500, Hasselt, Belgium.|Department of Cardiology, Ziekenhuis Oost-Limburg Genk, Schiepse Bos 6, 3600, Genk, Belgium.
authors.forename: Jo
authors.initials: J
authors.lastname: Dens
authors.affiliation: Faculty of Medicine and Life Sciences, Hasselt University, Martelarenlaan 42, 3500, Hasselt, Belgium.|Department of Anesthesiology, Intensive Care, Emergency Medicine and Pain Therapy, Ziekenhuis Oost-Limburg Genk, Schiepse Bos 6, 3600, Genk, Belgium.
authors.forename: Cathy
authors.initials: C
authors.lastname: De Deyne
mesh_terms: D000368:Aged; D016887:Cardiopulmonary Resuscitation / Q000379:methods*; D002560:Cerebrovascular Circulation / Q000502:physiology*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007036:Hypothermia, Induced / Q000379:methods*; D008297:Male; D008875:Middle Aged; D058687:Out-of-Hospital Cardiac Arrest / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000628:therapy*; D011446:Prospective Studies; D019265:Spectroscopy, Near-Infrared / Q000379:methods*
keywords: Cerebral saturation; Neurological outcome; Neuromonitoring; Post-cardiac arrest; Targeted temperature management