Near‐infrared Spectroscopy Monitoring During Cardiac Arrest: A Systematic Review and Meta‐analysis

作者：Alexis, Cournoyer; Massimiliano, Iseppon; Jean‐Marc, Chauny; André, Denault; Sylvie, Cossette; Éric, Notebaert

来源：ACADEMIC EMERGENCY MEDICINE, 2016, 23(8): 851-862.

DOI：10.1111/acem.12980

<jats:title>Abstract</jats:title><jats:sec><jats:title>Background</jats:title><jats:p>Tissue oximetry using near‐infrared spectroscopy (<jats:styled-content style="fixed-case">NIRS</jats:styled-content>) is a noninvasive monitor of cerebral oxygenation. This new technology has been used during cardiac arrest (<jats:styled-content style="fixed-case">CA</jats:styled-content>) because of its ability to give measures in low‐blood‐flow situations. The aim of this study was to assess the evidence regarding the association between the types of <jats:styled-content style="fixed-case">NIRS</jats:styled-content> measurements (mean, initial, and highest values) and resuscitation outcomes (return of spontaneous circulation [<jats:styled-content style="fixed-case">ROSC</jats:styled-content>], survival to discharge, and good neurologic outcome) in patients undergoing cardiopulmonary resuscitation.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>This review was registered (Prospero <jats:styled-content style="fixed-case">CRD</jats:styled-content>42015017380) and is reported as per the <jats:styled-content style="fixed-case">PRISMA</jats:styled-content> guidelines. Medline, Embase, and <jats:styled-content style="fixed-case">CENTRAL</jats:styled-content> were searched. All studies, except case reports and case series of fewer than five patients, reporting on adults that had <jats:styled-content style="fixed-case">NIRS</jats:styled-content> monitoring during <jats:styled-content style="fixed-case">CA</jats:styled-content> were eligible for inclusion. Two reviewers assessed the quality of the included articles and extracted the data. The outcome effect was standardized using standardized mean difference (<jats:styled-content style="fixed-case">SMD</jats:styled-content>).</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>Twenty nonrandomized observational studies (15 articles and five conference abstracts) were included in this review, for a total of 2,436 patients. We found a stronger association between <jats:styled-content style="fixed-case">ROSC</jats:styled-content> and mean <jats:styled-content style="fixed-case">NIRS</jats:styled-content> values (<jats:styled-content style="fixed-case">SMD</jats:styled-content> = 1.33; 95% confidence interval [<jats:styled-content style="fixed-case">CI</jats:styled-content>] = 0.92 to 1.74) than between <jats:styled-content style="fixed-case">ROSC</jats:styled-content> and initial <jats:styled-content style="fixed-case">NIRS</jats:styled-content> measurements (<jats:styled-content style="fixed-case">SMD</jats:styled-content> = 0.51; 95% <jats:styled-content style="fixed-case">CI</jats:styled-content> = 0.23 to 0.78). There was too much heterogeneity among the highest <jats:styled-content style="fixed-case">NIRS</jats:styled-content> measurements group to perform meta‐analysis. Only two of the 75 patients who experienced <jats:styled-content style="fixed-case">ROSC</jats:styled-content> had a mean <jats:styled-content style="fixed-case">NIRS</jats:styled-content> saturation under 30%. Patients who survived to discharge and who had good neurologic outcome displayed superior combined initial and mean <jats:styled-content style="fixed-case">NIRS</jats:styled-content> values than their counterparts (<jats:styled-content style="fixed-case">SMD</jats:styled-content> = 1.63; 95% <jats:styled-content style="fixed-case">CI</jats:styled-content> = 1.34 to 1.92; and <jats:styled-content style="fixed-case">SMD</jats:styled-content> = 2.12; 95% <jats:styled-content style="fixed-case">CI</jats:styled-content> = 1.14 to 3.10).</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>Patients with good resuscitation outcomes have significantly higher <jats:styled-content style="fixed-case">NIRS</jats:styled-content> saturations during resuscitation than their counterparts. The types of <jats:styled-content style="fixed-case">NIRS</jats:styled-content> measurements during resuscitation influenced the association between <jats:styled-content style="fixed-case">ROSC</jats:styled-content> and <jats:styled-content style="fixed-case">NIRS</jats:styled-content> saturation. Prolonged failure to obtain a <jats:styled-content style="fixed-case">NIRS</jats:styled-content> saturation higher than 30% may be included in a multimodal approach to the decision of terminating resuscitation efforts (Class <jats:styled-content style="fixed-case">II</jats:styled-content>b, Level of Evidence C‐Limited Data).</jats:p></jats:sec>

• 出版日期2016-8
• 单位常州工学院