Integrated Near-Infrared Spectroscopy and Hemodynamic Monitoring for Cerebral Autoregulation in Post-Cardiac Arrest Care Neuroprognostication

Neurological outcome is the primary outcome for post-cardiac arrest patients. Hypoxic-ischemic brain injury is a key element in post-cardiac arrest syndrome, and remains the leading cause of mortality and morbidity in post-cardiac arrest patients. In patients with hypoxic-ischemic brain injury, impaired cerebral autoregulation makes cerebral blood flow highly vulnerable to blood pressure fluctuations, which might trigger secondary brain injuries. Although the pressure reactivity index (PRx) calculated via invasive intracranial pressure (ICP) monitoring is considered the gold standard for assessing cerebral autoregulation, its clinical application in post-cardiac arrest patients is limited due to invasive risks. Alternatively, cerebral near-infrared spectroscopy (NIRS) combined with hemodynamic monitoring offers a non-invasive approach to measure the cerebral oxygenation index (COx). However, its consistency with invasive methods and its accuracy in post-cardiac arrest care warrant further validation. The aim of this study is to assess cerebral autoregulation via COx calculated with NIRS and hemodynamic parameters in post-cardiac arrest patients, and to analyze the impact of this index on neurological outcomes. The further goal is to estimate optimal mean arterial pressure (MAPopt) and subsequently establish personalized post-resuscitation blood pressure targets.