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Near-infrared spectroscopy monitoring during out-of-hospital cardiac arrest: can the initial cerebral tissue oxygenation index predict ROSC?
  1. Jumpei Tsukuda1,
  2. Shigeki Fujitani1,
  3. Kenichiro Morisawa1,
  4. Nobuhiko Shimozawa1,
  5. Brandon D Lohman1,
  6. Kentaro Okamoto1,
  7. Takeshi Kawaguchi1,
  8. Yuka Takamatsu1,
  9. Shuichi Fujii1,
  10. Masayuki Ozaki1,
  11. Mahbubur Rahman2,
  12. Yasuhiko Taira1
  1. 1 Department of Emergency and Critical Care Medicine, St Marianna University School of Medicine, Kawasaki, Japan
  2. 2 Graduate School of Public Health, St Luke’s International University, Tsukiji, Japan
  1. Correspondence to Dr Yasuhiko Taira, Department of Emergency and Critical Care Medicine, St Marianna University School of Medicine, Kawasaki, Kanagawa 216-8511, Japan; y2taira{at}


Study objectives Near-infrared spectroscopy is a modality that can monitor tissue oxygenation index (TOI) and has potential to evaluate return of spontaneous circulation (ROSC) during cardiopulmonary resuscitation (CPR). This study’s objectives were to evaluate whether TOI could be associated with ROSC and used to help guide the decision to either terminate CPR or proceed to extracorporeal CPR (ECPR).

Methods In this observational study, we assessed the patients with out-of-hospital cardiac arrest with non-traumatic cause receiving CPR on arrival at our ED between 2013 and 2016. TOI monitoring was discontinued either on CPR termination after ROSC was reached or on patient death. Patients were classified into two groups: ROSC and non-ROSC group.

Results Out of 141 patients, 24 were excluded and the remaining 117 were classified as follows: ROSC group (n=44) and non-ROSC group (n=73). ROSC group was significantly younger and more likely to have their event witnessed and bystander CPR. ROSC group showed a higher initial TOI than non-ROSC group (60.5%±17.0% vs 37.9%±13.7%: p<0.01). Area under the curve analysis was more accurate with the initial TOI than without it for predicting ROSC (0.88, 95% CI 0.82 to 0.95 vs 0.79, 95% CI 0.70 to 0.87: p<0.01). TOI cut-off value ≥59% appeared to favour survival to hospital discharge whereas TOI ≤24% was associated with non-ROSC.

Conclusions This study demonstrated an association between higher initial TOI and ROSC. Initial TOI could increase the accuracy of ROSC prognosis and may be a clinical factor in the decision to terminate CPR and select patients who are to proceed to ECPR.

  • cardiac arrest
  • resuscitation

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  • Contributors JT, SF and YT conceived the research idea and designed the study. JT, KM, NS and TK supervised the study and collected the data. YT, KO and MO provided statistical advice on study design and analysed the data. SF chaired the data oversight committee. JT and BDL drafted the first version of the manuscript, and all authors contributed substantially to the subsequent version and revisions. MR contributed to the second revision and incorporated reviewers’ comments throughout the manuscript. YT takes public responsibility of the contents of this paper.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Not required.

  • Ethics approval The research protocol received approval from the ethics committee of the Institutional Review Board of St Marianna University School of Medicine.

  • Provenance and peer review Not commissioned; externally peer reviewed.