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Cerebral oxygenation monitoring in patients during and after cardiac arrest -- a narrative review of current methods and evidence

  • Jaromir Richter1
  • Jan Maca1
  • Nilay Chatterjee2
  • Peter Sklienka1
  • Adarsh Eshappa Setra2
  • Roman Zahorec3

1Department of Anesthesiology and Intensive Care Medicine, University Hospital Ostrava, 708 00 Ostrava, Czech Republic

2Department of Anaesthetics, Yeovil Hospital, BA21 4AT Yeovil, UK

3Second Department of Anesthesiology and Intensive Medicine, Medical School, Comenius University, 814 99 Bratislava, Slovak Republic

DOI: 10.22514/sv.2021.141 Vol.17,Issue 6,November 2021 pp.18-24

Submitted: 17 June 2021 Accepted: 20 July 2021

Published: 08 November 2021

*Corresponding Author(s): Jaromir Richter E-mail:


Hypoxic-ischemic brain injury (HIBI) is a leading cause of mortality in post-cardiac arrest (post-CA) patients who successfully survive the initial cardiopulmonary resuscitation (CPR) but later die in the Intensive Care Unit (ICU). Therefore, a key priority of post-resuscitation ICU care is to prevent and limit the impact of HIBI by optimizing the balance between cerebral oxygen delivery and demand. Traditionally, an optimal systemic oxygen balance is considered to ensure the brain’s oxygen balance. However, the validity of this assumption is uncertain, as the brain constitutes only 2% of the body mass while accounting for approximately 20% of basal oxygen consumption at rest. Hence, there is a real need to monitor cerebral oxygenation realistically. Several imaging and bedside monitoring methods are available for cerebral oxygenation monitoring in post-CA patients. Unfortunately, each of them has its limitations. Imaging methods require transporting a critically ill unstable patient to the scanner. Moreover, they provide an assessment of the oxygenation state only at a particular moment, while brain oxygenation is dynamic. Bedside methods, specifically near-infrared spectroscopy (NIRS), brain tissue oxygen tension (PbtO2), and jugular venous oxygen saturation monitoring (SjvO2), have not often been used in studies involving post-CA patients. Hence there is ambiguity regarding clear recommendations for using these bedside monitors. Presently, the most promising option seems to be using the NIRS as an indicator of effective CPR. We present a narrative review focusing on bedside methods and discuss the evidence for their use in adult patients after cardiac arrest.


Cerebral oxygenation monitoring; Near-infrared spectroscopy; Brain tissue oxygen tension monitoring; Jugular venous oxygen saturation monitoring

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Jaromir Richter,Jan Maca,Nilay Chatterjee,Peter Sklienka,Adarsh Eshappa Setra,Roman Zahorec. Cerebral oxygenation monitoring in patients during and after cardiac arrest -- a narrative review of current methods and evidence. Signa Vitae. 2021. 17(6);18-24.


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