Cerebral autoregulation in anoxic brain injury patients treated with targeted temperature management

Bibliographic Details
Title: Cerebral autoregulation in anoxic brain injury patients treated with targeted temperature management
Authors: Ilaria Alice Crippa, Jean-Louis Vincent, Federica Zama Cavicchi, Selene Pozzebon, Filippo Annoni, Antonella Cotoia, Hassane Njimi, Nicolas Gaspard, Jacques Creteur, Fabio Silvio Taccone
Source: Journal of Intensive Care, Vol 9, Iss 1, Pp 1-9 (2021)
Publisher Information: BMC, 2021.
Publication Year: 2021
Collection: LCC:Medical emergencies. Critical care. Intensive care. First aid
Subject Terms: Post-anoxic brain injury, Neurological outcome, Temperature management, Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
More Details: Abstract Background Little is known about the prevalence of altered CAR in anoxic brain injury and the association with patients’ outcome. We aimed at investigating CAR in cardiac arrest survivors treated by targeted temperature management and its association to outcome. Methods Retrospective analysis of prospectively collected data. Inclusion criteria: adult cardiac arrest survivors treated by targeted temperature management (TTM). Exclusion criteria: trauma; sepsis, intoxication; acute intra-cranial disease; history of supra-aortic vascular disease; severe hemodynamic instability; cardiac output mechanical support; arterial carbon dioxide partial pressure (PaCO2) > 60 mmHg; arrhythmias; lack of acoustic window. Middle cerebral artery flow velocitiy (FV) was assessed by transcranial Doppler (TCD) once during hypothermia (HT) and once during normothermia (NT). FV and blood pressure (BP) were recorded simultaneously and Mxa calculated (MATLAB). Mxa is the Pearson correlation coefficient between FV and BP. Mxa > 0.3 defined altered CAR. Survival was assessed at hospital discharge. Cerebral Performance Category (CPC) 3–5 assessed 3 months after CA defined unfavorable neurological outcome (UO). Results We included 50 patients (Jan 2015–Dec 2018). All patients had out-of-hospital cardiac arrest, 24 (48%) had initial shockable rhythm. Time to return of spontaneous circulation was 20 [10–35] min. HT (core body temperature 33.7 [33.2–34] °C) lasted for 24 [23–28] h, followed by rewarming and NT (core body temperature: 36.9 [36.6–37.4] °C). Thirty-one (62%) patients did not survive at hospital discharge and 36 (72%) had UO. Mxa was lower during HT than during NT (0.33 [0.11–0.58] vs. 0.58 [0.30–0.83]; p = 0.03). During HT, Mxa did not differ between outcome groups. During NT, Mxa was higher in patients with UO than others (0.63 [0.43–0.83] vs. 0.31 [− 0.01–0.67]; p = 0.03). Mxa differed among CPC values at NT (p = 0.03). Specifically, CPC 2 group had lower Mxa than CPC 3 and 5 groups. At multivariate analysis, initial non-shockable rhythm, high Mxa during NT and highly malignant electroencephalography pattern (HMp) were associated with in-hospital mortality; high Mxa during NT and HMp were associated with UO. Conclusions CAR is frequently altered in cardiac arrest survivors treated by TTM. Altered CAR during normothermia was independently associated with poor outcome.
Document Type: article
File Description: electronic resource
Language: English
ISSN: 2052-0492
Relation: https://doaj.org/toc/2052-0492
DOI: 10.1186/s40560-021-00579-z
Access URL: https://doaj.org/article/664ba7e7a82e48cbbe514b81a23f40f7
Accession Number: edsdoj.664ba7e7a82e48cbbe514b81a23f40f7
Database: Directory of Open Access Journals
More Details
ISSN:20520492
DOI:10.1186/s40560-021-00579-z
Published in:Journal of Intensive Care
Language:English