{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,31]],"date-time":"2026-03-31T05:32:57Z","timestamp":1774935177605,"version":"3.50.1"},"reference-count":41,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2025,12,8]],"date-time":"2025-12-08T00:00:00Z","timestamp":1765152000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"DOI":"10.13039\/100022733","name":"FinnHEMS","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100022733","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100008376","name":"Helsingin ja Uudenmaan Sairaanhoitopiiri","doi-asserted-by":"publisher","award":["state funding, TYH2021224 and TYH2022320"],"award-info":[{"award-number":["state funding, TYH2021224 and TYH2022320"]}],"id":[{"id":"10.13039\/100008376","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Acta Anaesthesiol Scand"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>\n                      Many patients undergoing prehospital anaesthesia may be at risk of inadequate cerebral oxygenation due to underlying conditions or adverse events like hypotension or hypoxia. This study examined whether a decrease in regional cerebral oxygen saturation (rSO\n                      <jats:sub>2<\/jats:sub>\n                      ) measured with near\u2010infrared spectroscopy (NIRS) during prehospital anaesthesia associates with worse outcomes.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      We conducted a prospective, observational study including adult patients anaesthetised by six prehospital critical care teams. A relative cerebral desaturation event (rCDE) was defined as a\u2009\u2265\u200910% decrease in rSO\n                      <jats:sub>2<\/jats:sub>\n                      for \u2265\u20095\u2009min from baseline. An absolute cerebral desaturation event (aCDE) was defined as rSO\n                      <jats:sub>2<\/jats:sub>\n                      \u2009&lt;\u200960% during anaesthesia or lower than baseline if already &lt;\u200960%. The primary outcome was favourable functional outcome (modified Rankin Scale \u2264\u20092) at 30\u2009days and secondary outcomes included 30\u2010day survival, 1\u2010year functional outcome, and 1\u2010year survival.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Among 1014 patients, 199 experienced an rCDE, with 125 (63%) having supraphysiological baseline. rCDE was not associated with outcomes. Of 182 patients with aCDE, 30\u2010day favourable outcomes were not significantly different (30% vs. 36%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.14, adjusted OR 0.92, 95% confidence interval 0.62\u20131.34). However, aCDE was associated with lower 30\u2010day survival (46% vs. 58%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.006) and less favourable 1\u2010year outcomes (31% vs. 41%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.043). Adjusted analyses showed no significant associations.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>An rCDE was not associated with worse functional outcomes. While aCDEs were linked to unfavourable outcomes in unadjusted analyses, these associations were not significant after adjustment, highlighting the complexity of interpreting NIRS in heterogeneous populations. Condition\u2010specific studies are needed to clarify its role.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Editorial Comment<\/jats:title>\n                    <jats:p>Cerebral oxygen delivery may be jeopardized in critically ill patients undergoing prehospital anaesthesia. This study assessed near\u2010infrared spectroscopy on the forehead in a large number of cases requiring general anaesthesia and subsequent transportation to hospital by helicopter. In unadjusted analysis, patients with an at least 10% decline in forehead saturation had higher survival and better functional outcome, whereas those with a forehead saturation below 60% had lower survival and worse functional outcome. Upon multivariable regression, age, patient category, systemic oxygen saturation and Glasgow Coma Scale score were independent predictors of worse outcomes, but forehead oxygen saturation was not. NIRS\u2010measured forehead saturation decrease appears to associate in a complex fashion with more traditional predictors of patient outcomes. Whether effects of resuscitation interventions like these can be assessed reliably by NIRS is not yet well understood.<\/jats:p>\n                    <jats:p>\n                      <jats:bold>Trial registration:<\/jats:bold>\n                      The study protocol was published beforehand on\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" xlink:href=\"http:\/\/clinicaltrials.gov\">clinicaltrials.gov<\/jats:ext-link>\n                      (NCT04144803) on 7th October 2019\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/aas.70161","type":"journal-article","created":{"date-parts":[[2025,12,8]],"date-time":"2025-12-08T22:39:50Z","timestamp":1765233590000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Association of Cerebral Oxygenation During Prehospital Anaesthesia and Functional Outcome: A Prospective, Observational Multi\u2010Centre Cohort Study of 1014 Patients"],"prefix":"10.1111","volume":"70","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5052-4628","authenticated-orcid":false,"given":"Anssi","family":"Saviluoto","sequence":"first","affiliation":[{"name":"Emergency Medicine and Services, University of Helsinki and Helsinki University Hospital  Helsinki Finland"},{"name":"Wellbeing Services County of Central Finland, Hospital Nova  Jyv\u00e4skyl\u00e4 Finland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5537-9749","authenticated-orcid":false,"given":"Lasse","family":"Raatiniemi","sequence":"additional","affiliation":[{"name":"HEMS Unit, Division of Prehospital Emergency Care, Oulu University Hospital  Oulu Finland"},{"name":"Research Group of Surgery, Anaesthesiology and Intensive Care, Division of Anaesthesiology, Oulu University Hospital, Medical Research Centre, University of Oulu  Oulu Finland"},{"name":"The Arctic University of Norway  Troms\u00f6 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