Article Data

  • Views 448
  • Dowloads 146

Original Research

Open Access

Initial five and ten-minute regional cerebral oxygen saturation as a predictor of the futility of resuscitation for out-of-hospital cardiac arrest

  • Jae Ho Jang1
  • Yong Su Lim1
  • Woo Sung Choi1
  • Jea Yeon Choi1
  • Jin Seong Cho1
  • Jae-Hyug Woo1
  • Hyuk Jun Yang1

1Department of Emergency Medicine, Gil Medical Center, Gachon University College of Medicine, 21556 Incheon, Republic of Korea

DOI: 10.22514/sv.2022.027

Submitted: 03 December 2021 Accepted: 10 February 2022

Online publish date: 01 April 2022

*Corresponding Author(s): Yong Su Lim E-mail:


This study aimed to investigate the usefulness of cerebral regional oxygen saturation (rSO2) during the initial 5 and 10 minutes of cardiopulmonary resuscitation (CPR) compared with an initial rSO2 and mean rSO2 during entire CPR to predict the futility of resuscitation for patients without of-hospital-cardiac arrest (OHCA). This was a prospective study involving 52 adult patients presenting in OHCA and whose cerebral rSO2 values were measured until either CPR was terminated or sustained return of spontaneous circulation (ROSC) was achieved. Receiver operating characteristics analyses were used to evaluate which time and type of measurement is better to predict non-ROSC. The area under the curve (AUC) of each rSO2 value according to measurement time (overall, initial 5 minutes and 10 minutes) were the highest value of 0.743, 0.724, and 0.739, mean values of 0.724, 0.677 and 0.701 and ∆rSO2 (Changes in values of regional cerebral oxygen) value of 0.722, 0.734 and 0.724, respectively, while all of the initial values had a poor AUC (<0.7) and also were not statistically significant. The optimal cut-off value of each rSO2 values during overall, initial 5 minutes and 10 minutes were the highest value of 26% (sensitivity, 53.9%; specificity, 92.3%), 24% (sensitivity, 56.4%; specificity, 92.3%), and 30% (sensitivity, 61.5%; specificity, 84.6%), mean value of 15.2%, 15.3% and 16%, respectively. None of the patients with a persistent rSO2 ≤18% during the overall period achieved ROSC. Initial 5 minutes and 10 minutes cerebral rSO2 values an out-of-hospital-cardiac arrest (OHCA) are a better predictor in deciding the futility of CPR, compared to initial and overall measurements.


Out-of-hospital cardiac arrest; Cardiopulmonary resuscitation; Cerebral oximetry; Near-infrared spectroscopy; Futility of CPR

Cite and Share

Jae Ho Jang,Yong Su Lim,Woo Sung Choi,Jea Yeon Choi,Jin Seong Cho,Jae-Hyug Woo,Hyuk Jun Yang. Initial five and ten-minute regional cerebral oxygen saturation as a predictor of the futility of resuscitation for out-of-hospital cardiac arrest. Signa Vitae. 2022.doi:10.22514/sv.2022.027.


[1] KimTH, Shin SD, Kim YJ, Kim CH, Kim JE. The scene time interval and basic life support termination of resuscitation rule in adult out-of-hospital cardiac arrest. The Journal of Korean Medical Science. 2015; 30: 104–109.

[2] Kajino K, Iwami T, Daya M, Nishiuchi T, Hayashi Y, Kitamura T, et al. Impact of transport to critical care medical centers on outcomes after out-of-hospital cardiac arrest. Resuscitation. 2010; 81: 549–554.

[3] Morrison LJ, Visentin LM, Kiss A, Theriault R, Eby D, Vermeulen M, et al. Validation of a rule for termination of resuscitation in out-of-hospital cardiac arrest. New England Journal of Medicine. 2006; 355: 478–487.

[4] Goto Y, Maeda T, Goto YN. Termination-of-resuscitation rule for emergency department physicians treating out-of-hospital cardiac arrest patients: an observational cohort study. Critical Care. 2013; 17: R235.

[5] Genbrugge C, Dens J, Meex I, Boer W, Eertmans W, Sabbe M, et al. Regional cerebral oximetry during cardiopulmonary resuscitation: useful or useless? The Journal of Emergency Medicine. 2016; 50: 198–207.

[6] Friess SH, Sutton RM, French B, Bhalala U, Maltese MR, Naim MY, et al. Hemodynamic directed CPR improves cerebral perfusion pressure and brain tissue oxygenation. Resuscitation. 2014; 85: 1298–1303.

[7] Cournoyer A, Iseppon M, Chauny JM, Denault A, Cossette S, Notebaert É. Near-infrared spectroscopy monitoring during cardiac arrest: a systematic review and meta-analysis. Academic Emergency Medicine. 2016; 23: 851–862.

[8] Zaouter C, Arbeid E. Influence of ambient light on cerebral oximeters. British Journal of Anaesthesia. 2010; 105: 873–874.

[9] Ito N, Nanto S, Nagao K, Hatanaka T, Kai T. Regional cerebral oxygen saturation predicts poor neurological outcome in patients with out-of-hospital cardiac arrest. Resuscitation. 2010; 81: 1736–1737.

[10] Fukuda T, Ohashi N, Nishida M, Gunshin M, Doi K, Matsubara T, et al. Application of cerebral oxygen saturation to the prediction of the futility of resuscitation for out-of-hospital cardiopulmonary arrest patients: a single-center, prospective, observational study: can cerebral regional oxygen saturation predict the futility of CPR? The American Journal of Emergency Medicine. 2014; 32: 747–751.

[11] Genbrugge C, Eertmans W, Jans F, Boer W, Dens J, De Deyne C. Regional cerebral saturation monitoring during withdrawal of life support until death. Resuscitation. 2017; 121: 147–150.

[12] Parnia S, Nasir A, Shah C, Patel R, Mani A, Richman P. A feasibility study evaluating the role of cerebral oximetry in predicting the return of spontaneous circulation in cardiac arrest. Resuscitation. 2012; 83: 982–985.

[13] Genbrugge C, Meex I, Boer W, Jans F, Heylen R, Ferdinande B, et al. Increase in cerebral oxygenation during advanced life support in out-of-hospital patients is associated with the return of spontaneous circulation. Critical Care. 2015; 19: 112.

[14] Schnaubelt S, Sulzgruber P, Menger J, Skhirtladze-Dworschak K, Sterz F, Dworschak M. Regional cerebral oxygen saturation during cardiopulmonary resuscitation as a predictor of return of spontaneous circulation and favorable neurological outcome—a review of the current literature. Resuscitation. 2018; 125: 39–47.

[15] Nishiyama K, Ito N, Orita T, Hayashida K, Arimoto H, Abe M, et al. Characteristics of regional cerebral oxygen saturation levels in patients with out-of-hospital cardiac arrest with or without return of spontaneous circulation: a prospective observational multicentre study. Resuscitation. 2015; 96: 16–22.

[16] Moerman A, Wouters P. Near-infrared spectroscopy (NIRS) monitoring in contemporary anesthesia and critical care. Acta Anaesthesiologica Belgica. 2010; 61:185–194.

[17] Brady K, Joshi B, Zweifel C, Smielewski P, Czosnyka M, Easley RB, et al. Real-time continuous monitoring of cerebral blood flow autoregulation using near-infrared spectroscopy in patients undergoing cardiopulmonary bypass. Stroke. 2010; 41: 1951–1956.

[18] Sanfilippo F, Serena G, Corredor C, Benedetto U, Maybauer MO, Al-Subaie N, et al. Cerebral oximetry and return of spontaneous circulation after cardiac arrest: a systematic review and meta-analysis. Resuscitation. 2015; 94: 67–72.

[19] Yagi T, Nagao K, Kawamorita T, Soga T, Ishii M, Chiba N, et al. Detection of ROSC in patients with cardiac arrest during chest compression using nirs: a pilot study. Advances in Experimental Medicine and Biology. 2016; 876: 151–157.

[20] Meex I, De Deyne C, Dens J, Scheyltjens S, Lathouwers K, Boer W, et al. Feasibility of absolute cerebral tissue oxygen saturation during cardiopulmonary resuscitation. Critical Care. 2013; 17: R36.

[21] Ahn A, Nasir A, Malik H, D’Orazi F, Parnia S. A pilot study examining the role of regional cerebral oxygen saturation monitoring as a marker of return of spontaneous circulation in shockable (VF/VT) and non-shockable (PEA/Asystole) causes of cardiac arrest. Resuscitation. 2013; 84: 1713–1716.

[22] Berg RA, Sanders AB, Kern KB, Hilwig RW, Heidenreich JW, Porter ME, et al. Adverse hemodynamic effects of interrupting chest compressions for rescue breathing during cardiopulmonary resuscitation for ventricular fibrillation cardiac arrest. Circulation. 2001; 104: 2465–2470.

[23] Parnia S, Yang J, Nguyen R, Ahn A, Zhu J, Inigo-Santiago L, et al. Cerebral Oximetry during Cardiac Arrest: a multicenter study of neurologic outcomes and survival. Critical Care Medicine. 2016; 44: 1663–1674.

[24] Takegawa R, Hayashida K, Rolston DM, Li T, Miyara SJ, Ohnishi M, et al. Near-infrared spectroscopy assessments of regional cerebral oxygen saturation for the prediction of clinical outcomes in patients with cardiac arrest: a review of clinical impact, evolution, and future directions. Frontiers in Medicine. 2020; 7: 587930.

Abstracted / indexed in

Science Citation Index Expanded (SciSearch) Created as SCI in 1964, Science Citation Index Expanded now indexes over 9,200 of the world’s most impactful journals across 178 scientific disciplines. More than 53 million records and 1.18 billion cited references date back from 1900 to present.

Journal Citation Reports/Science Edition Journal Citation Reports/Science Edition aims to evaluate a journal’s value from multiple perspectives including the journal impact factor, descriptive data about a journal’s open access content as well as contributing authors, and provide readers a transparent and publisher-neutral data & statistics information about the journal.

Chemical Abstracts Service Source Index The CAS Source Index (CASSI) Search Tool is an online resource that can quickly identify or confirm journal titles and abbreviations for publications indexed by CAS since 1907, including serial and non-serial scientific and technical publications.

IndexCopernicus The Index Copernicus International (ICI) Journals database’s is an international indexation database of scientific journals. It covered international scientific journals which divided into general information, contents of individual issues, detailed bibliography (references) sections for every publication, as well as full texts of publications in the form of attached files (optional). For now, there are more than 58,000 scientific journals registered at ICI.

Geneva Foundation for Medical Education and Research The Geneva Foundation for Medical Education and Research (GFMER) is a non-profit organization established in 2002 and it works in close collaboration with the World Health Organization (WHO). The overall objectives of the Foundation are to promote and develop health education and research programs.

Scopus: CiteScore 0.5(2021) Scopus is Elsevier's abstract and citation database launched in 2004. Scopus covers nearly 36,377 titles (22,794 active titles and 13,583 Inactive titles) from approximately 11,678 publishers, of which 34,346 are peer-reviewed journals in top-level subject fields: life sciences, social sciences, physical sciences and health sciences.

Embase Embase (often styled EMBASE for Excerpta Medica dataBASE), produced by Elsevier, is a biomedical and pharmacological database of published literature designed to support information managers and pharmacovigilance in complying with the regulatory requirements of a licensed drug.

Submission Turnaround Time