Neurologic injury is a leading cause of morbidity and mortality following pediatric cardiac arrest. In this study, we assess the feasibility of quantitative, non-invasive, frequency-domain diffuse optical spectroscopy (FD-DOS) neuromonitoring during cardiopulmonary resuscitation (CPR), and its predictive utility for return of spontaneous circulation (ROSC) in an established pediatric swine model of cardiac arrest. Cerebral tissue optical properties, oxy- and deoxy-hemoglobin concentration ([HbO 2], [Hb]), oxygen saturation (StO 2) and total hemoglobin concentration (THC) were measured by a FD-DOS probe placed on the forehead in 1-month-old swine (8-11 kg; n = 52) during seven minutes of asphyxiation followed by twenty minutes of CPR. ROSC prediction and time-dependent performance of prediction throughout early CPR (< 10 min), were assessed by the weighted Youden index (J w, w = 0.1) with tenfold cross-validation. FD-DOS CPR data was successfully acquired in 48/52 animals; 37/48 achieved ROSC. Changes in scattering coefficient (785 nm), [HbO 2], StO 2 and THC from baseline were significantly different in ROSC versus No-ROSC subjects (p < 0.01) after 10 min of CPR. Change in [HbO 2] of + 1.3 µmol/L from 1-min of CPR achieved the highest weighted Youden index (0.96) for ROSC prediction. We demonstrate feasibility of quantitative, non-invasive FD-DOS neuromonitoring, and stable, specific, early ROSC prediction from the third minute of CPR.
Bibliographical noteFunding Information:
Direct research support was provided by the National Institutes of Health (NIH) F31-HD085731, T32-HL007915 [TSK]; K23-HL148541 [RWM]; TL1-TR001880 [AMM]; R21-HD089132 [RAB, RMS, RWM]; U01-HD063108 [RAB]; R01-NS060653 [AGY, DJL]; P41-EB015893 [AGY, WBB, WG]; R01-NS72338 [DJL]; R01-HL141386 [TJK, RAB, RWM, RMS, DJL]; the Department of Defense (DOD) W81XWH-16-PRMRP-TTDA [TJK]; the Children’s Hospital of Philadelphia (CHOP) Cardiac Center [CDM]; and the June and Steve Wolfson Family Foundation [DJL]. Funding organizations were not involved in the conduct of research nor the preparation of this article.
© 2021, The Author(s).