Monitoring the Brain after Cardiac Arrest: Techniques and Potential Clinical Utility

Abstract

Cardiac arrest causes global hypoxia-ischemia, and reperfusion, with subsequent deleterious consequences on cerebral perfusion and oxygenation, as well as cell metabolism. Given the current lack of specific therapies to reverse or attenuate global hypoxic-ischemic brain injury, treatment is mainly supportive, aiming at optimize cerebral perfusion and oxygenation. In this setting, multimodal brain monitoring may be useful by helping clinicians to target optimal cerebral perfusion (e.g., blood arterial pressure thresholds) and oxygenation, thereby potentially attenauating secondary brain injury. The aim of this review was to discuss the available non-invasive techniques (e.g., transcranial Doppler, near infrared spectroscopy, electroencephalography, and automated infrared pupillometry) and describe their potential utility and limitations, with regard to acute phase management (optimization of perfusion and cerebral oxygenation) and early prognostication of post-cardiac arrest patients.