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ORIGINAL RESEARCH article

Front. Med.

Sec. Intensive Care Medicine and Anesthesiology

Volume 12 - 2025 | doi: 10.3389/fmed.2025.1590908

This article is part of the Research TopicDetrimental Effects of Hypoxia on Brain and Cognitive FunctionsView all 5 articles

Comprehensive pre-and in-hospital near-infraredspectroscopy (NIRS) after return of spontaneous circulation predicts neurological outcome after out-ofhospital cardiac arrest -A prospective observational study and literature review

Provisionally accepted
Sebastian  SchnaubeltSebastian Schnaubelt1*Andrea  KornfehlAndrea Kornfehl1Felix  EibensteinerFelix Eibensteiner1Christoph  VeiglChristoph Veigl1Florian  B MayrFlorian B Mayr2Patrick  AignerPatrick Aigner3Mathias  GatterbauerMathias Gatterbauer3Michael  GirsaMichael Girsa3Daniel  GrassmannDaniel Grassmann3Andreas  ZajicekAndreas Zajicek3Alexander  SpielAlexander Spiel4Wolfgang  SchreiberWolfgang Schreiber1Michael  HolzerMichael Holzer1Heidrun  LosertHeidrun Losert1Mario  KrammelMario Krammel3Thomas  UrayThomas Uray1
  • 1Medical University of Vienna, Vienna, Austria
  • 2University of Pittsburgh, Pittsburgh, Pennsylvania, United States
  • 3Emergency Medical Service Vienna, Vienna, Austria
  • 4Klinik Ottakring, Vienna, Austria

The final, formatted version of the article will be published soon.

Background: An increase in regional cerebral oxygen saturation (rSO2) levels during advanced life support in patients with out-of hospital cardiac arrest (OHCA) is associated with return of spontaneous circulation (ROSC) and can predict neurological outcome. Data from the post-ROSC phase are scarce but may predict clinical outcomes as well.Methods: For this prospective observational study, we measured rSO2 via near-infraredspectroscopy (NIRS) in patients after ROSC following OHCA in both the pre-and in-hospital setting for up to 72 hours. Patients were followed up for their post-ROSC treatment and outcomes. NIRS values were then compared between patients with favourable and nonfavourable neurological outcome, and cut-off values were assessed via Receiver Operating Characteristic (ROC) and Classification and Regression Trees (CART) analyses. In addition, a narrative review on the topic was performed.Results: Of the 27 included patients, 37% survived to hospital discharge, and 26% showed favourable neurological outcomes (CPC 1 or 2). RSO2 was significantly higher in individuals with CPC 1/2 (67 [60-69] % vs. 59 [50-70] %; p = 0.049). This was even more pronounced for initial (= a mean of the first five minutes) NIRS values (70 [65-77] % vs. 57 [49-68] %; p = 0.025) and NIRS values rising in the first 10 minutes (43% vs. 5% of patients; p = 0.042). A ROC analysis for initial rSO2 showed a significant discriminatory power to predict CPC 1/2 (AUC = 0.789, p = 0.025), and both ROC and CART analyses suggested an optimal cut-off of around 62% rSO2.We identified a potential RSO2 cut off measured via NIRS in the post-ROSC phase after OHCA to predict favourable neurological outcome. Initial values and rising dynamics could be more useful for prognostication than a prolonged measurement at the ICU.These findings fit into previous literature and should trigger larger respective trials on the one, and the technology being addressed by resuscitation societies on the other hand.

Keywords: cerebral oxygenation, near-infrared spectroscopy, NIRS, Cardiac arrest, Cardiopulmonary Resuscitation, CPR, prognostication

Received: 10 Mar 2025; Accepted: 04 Aug 2025.

Copyright: © 2025 Schnaubelt, Kornfehl, Eibensteiner, Veigl, Mayr, Aigner, Gatterbauer, Girsa, Grassmann, Zajicek, Spiel, Schreiber, Holzer, Losert, Krammel and Uray. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: Sebastian Schnaubelt, Medical University of Vienna, Vienna, Austria

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