The pitfalls of bedside regional cerebral oxygen saturation in the early stage of post cardiac arrestReport as inadecuate

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Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine

, 23:95

First Online: 11 November 2015Received: 23 May 2015Accepted: 28 October 2015


It remains uncertain whether neuromonitoring reliably predicts outcome in adult post-cardiac arrest patients in the early stage treated with therapeutic hypothermia. Recent reports demonstrated a regional cerebral oxygen saturation of cardiac arrest patients on hospital arrival could predict their neurological outcome. There has been little discussion about the significance of regional cerebral oxygen saturation in patients with post-cardiac arrest syndrome. Amplitude-integrated electroencephalography monitoring may also provide early prognostic information for post-cardiac arrest syndrome. However, even when the initial electroencephalography is flat after the return of spontaneous circulation, good neurological outcome may still be obtainable if the electroencephalography shifts to a continuous pattern. The electroencephalography varied from flat to various patterns, such as flat, epileptic, or continuous during the first 24 h, while regional cerebral oxygen saturation levels varied even when the electroencephalography was flat. It is therefore difficult to estimate whether regional cerebral oxygen saturation accurately indicates the coupling of cerebral blood flow and metabolism in the early stage after cardiac arrest. Careful assessment of prognosis is necessary when relying solely on regional cerebral oxygen saturation as a single monitoring modality.

KeywordsCardiac arrest Post-cardiac arrest patients Regional cerebral oxygen saturation Amplitude-integrated electroencephalography AbbreviationsPCASPost-cardiac arrest syndrome

rSO2Regional cerebral oxygen saturation

ROSCReturn of spontaneous circulation


CMRO2Cerebral metabolic rate of oxygen

CBFCerebral blood flow

aEEGAmplitude-integrated electroencephalography

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Author: Kosaku Kinoshita - Atsushi Sakurai - Shingo Ihara


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