|
Author |
Jacob Hutton |
Date |
2020-08-20 |
|
Reviewer |
- |
Edited |
2020-10-22 |
After obtaining return of spontaneous circulation (ROSC) and transporting an adult patient who suffered an out-of-hospital cardiac arrest (OHCA) to the hospital, you wonder if there are any technological options for monitoring effectiveness of CPR and predicting ROSC in the pre-hospital setting.
“For patients in the pre-hospital setting who experience sudden cardiac arrest, does the use of cerebral oximetry provide actionable feedback on CPR quality and predict likelihood of ROSC?”
|
Population |
Adult patients in the pre-hospital setting who experience sudden cardiac arrest |
|
Intervention |
The use of a device monitoring cerebral oxygenation |
|
Comparison |
Standard CPR with no device |
|
Outcome |
Prediction of ROSC and evaluation of CPR quality |
PubMed: cerebral oximetry AND ("cardiac arrest" OR "CPR") AND ("EMS" OR "ambulance" OR "prehospital")
11 Results (8 Relevant) on 2020-08-20
While CPR best practices currently emphasize the importance of maintaining cerebral perfusion during cardiac arrest, many providers in the pre-hospital setting have few tools to actively monitor effectiveness of resuscitation in real-time. The use of cerebral oximetry devices in the prehospital setting has been shown to outperform end-tidal CO2 (ETCO2) in predicting ROSC. Patients who achieve ROSC exhibit a rapid and sustained rise in cerebral oxygenation, with normalization following ROSC. Persistently low levels of cerebral oxygenation have been shown to predict poor neurological outcomes.
The use of these devices may serve as a foundation for the next generation of CPR practices focused on neurological resuscitation, allowing prehospital providers to use real-time neuromonitoring to target cerebral perfusion. Small, compact devices are available and have been trialed in the ambulance setting with success. Cerebral oximetry also has the potential to be useful in prognostication and discontinuation of resuscitation and can be an effective tool in providing good data to increase quality of care. More research should be conducted on the economic and operational feasibility of its implementation at the ALS and BLS level.