K Ameloot1, C Genbrugge2, I Meex2, F Jans2, W Boer3, M Vander Laenen3, B Ferdinande4, W Mullens5, M Dupont4, J Dens5, C DeDeyne2. 1. Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium. Electronic address: Koen.ameloot@zol.be. 2. Department of Anesthesiology and Critical Care Medicine, Ziekenhuis Oost-Limburg, Genk, Belgium; Faculty of Medicine and Life Sciences, University Hasselt, Diepenbeek, Belgium. 3. Department of Anesthesiology and Critical Care Medicine, Ziekenhuis Oost-Limburg, Genk, Belgium. 4. Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium. 5. Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium; Faculty of Medicine and Life Sciences, University Hasselt, Diepenbeek, Belgium.
Abstract
AIMS: A subgroup of patients with ROSC after cardiac arrest (CA) with disturbed cerebral autoregulation might benefit from higher mean arterial pressures (MAP). We aimed to (1) phenotype patients with disturbed autoregulation, (2) investigate whether these patients have a worse prognosis, (3) define an individual optimal MAP per patient and (4) investigate whether time under this individual optimal MAP is associated with outcome. METHODS: Prospective observational study in 51 post-CA patients monitored with near infrared spectroscopy. RESULTS: (1) 18/51 patients (35%) had disturbed autoregulation. Phenotypically, a higher proportion of patients with disturbed autoregulation had pre-CA hypertension (31±47 vs. 65±49%, p=0.02) suggesting that right shifting of autoregulation is caused by chronic adaptation of cerebral blood flow to higher blood pressures. (2) In multivariate analysis, patients with preserved autoregulation (n=33, 65%) had a significant higher 180-days survival rate (OR 4.62, 95% CI [1.06:20.06], p=0.04]. Based on an index of autoregulation (COX), the average COX-predicted optimal MAP was 85 mmHg in patients with preserved and 100 mmHg in patients with disturbed autoregulation. (3) An individual optimal MAP could be determined in 33/51 patients. (4) The time under the individual optimal MAP was negatively associated with survival (OR 0.97, 95% CI [0.96:0.99], p=0.02). The time under previously proposed fixed targets (65, 70, 75, 80 mmHg) was not associated with a differential survival rate. CONCLUSION: Cerebral autoregulation showed to be disturbed in 35% of post-CA patients of which a majority had pre-CA hypertension. Disturbed cerebral autoregulation within the first 24h after CA is associated with a worse outcome. In contrast to uniform MAP goals, the time spent under a patient tailored optimal MAP, based on an index of autoregulation, was negatively associated with survival.
AIMS: A subgroup of patients with ROSC after cardiac arrest (CA) with disturbed cerebral autoregulation might benefit from higher mean arterial pressures (MAP). We aimed to (1) phenotype patients with disturbed autoregulation, (2) investigate whether these patients have a worse prognosis, (3) define an individual optimal MAP per patient and (4) investigate whether time under this individual optimal MAP is associated with outcome. METHODS: Prospective observational study in 51 post-CA patients monitored with near infrared spectroscopy. RESULTS: (1) 18/51 patients (35%) had disturbed autoregulation. Phenotypically, a higher proportion of patients with disturbed autoregulation had pre-CA hypertension (31±47 vs. 65±49%, p=0.02) suggesting that right shifting of autoregulation is caused by chronic adaptation of cerebral blood flow to higher blood pressures. (2) In multivariate analysis, patients with preserved autoregulation (n=33, 65%) had a significant higher 180-days survival rate (OR 4.62, 95% CI [1.06:20.06], p=0.04]. Based on an index of autoregulation (COX), the average COX-predicted optimal MAP was 85 mmHg in patients with preserved and 100 mmHg in patients with disturbed autoregulation. (3) An individual optimal MAP could be determined in 33/51 patients. (4) The time under the individual optimal MAP was negatively associated with survival (OR 0.97, 95% CI [0.96:0.99], p=0.02). The time under previously proposed fixed targets (65, 70, 75, 80 mmHg) was not associated with a differential survival rate. CONCLUSION: Cerebral autoregulation showed to be disturbed in 35% of post-CA patients of which a majority had pre-CA hypertension. Disturbed cerebral autoregulation within the first 24h after CA is associated with a worse outcome. In contrast to uniform MAP goals, the time spent under a patient tailored optimal MAP, based on an index of autoregulation, was negatively associated with survival.
Authors: Jerry P Nolan; Robert A Berg; Clifton W Callaway; Laurie J Morrison; Vinay Nadkarni; Gavin D Perkins; Claudio Sandroni; Markus B Skrifvars; Jasmeet Soar; Kjetil Sunde; Alain Cariou Journal: Intensive Care Med Date: 2018-06-02 Impact factor: 17.440
Authors: Yew Woon Chia; Shir Lynn Lim; Julian Kenrick Loh; Benjamin Sieu-Hon Leong; Marcus Eng Hock Ong Journal: Singapore Med J Date: 2021-08 Impact factor: 1.858
Authors: Matthew P Kirschen; Tanmay Majmudar; Forrest Beaulieu; Ryan Burnett; Mohammed Shaik; Ryan W Morgan; Wesley Baker; Tiffany Ko; Ramani Balu; Kenya Agarwal; Kristen Lourie; Robert Sutton; Todd Kilbaugh; Ramon Diaz-Arrastia; Robert Berg; Alexis Topjian Journal: Resuscitation Date: 2021-09-29 Impact factor: 6.251
Authors: Jerry P Nolan; Claudio Sandroni; Bernd W Böttiger; Alain Cariou; Tobias Cronberg; Hans Friberg; Cornelia Genbrugge; Kirstie Haywood; Gisela Lilja; Véronique R M Moulaert; Nikolaos Nikolaou; Theresa Mariero Olasveengen; Markus B Skrifvars; Fabio Taccone; Jasmeet Soar Journal: Intensive Care Med Date: 2021-03-25 Impact factor: 17.440
Authors: Matthew P Kirschen; Tanmay Majmudar; Ramon Diaz-Arrastia; Robert Berg; Benjamin S Abella; Alexis Topjian; Ramani Balu Journal: Resuscitation Date: 2022-03-08 Impact factor: 6.251
Authors: Hadie Adams; Joseph Donnelly; Marek Czosnyka; Angelos G Kolias; Adel Helmy; David K Menon; Peter Smielewski; Peter J Hutchinson Journal: PLoS Med Date: 2017-07-25 Impact factor: 11.069
Authors: Matthew P Kirschen; Ryan W Morgan; Tanmay Majmudar; William P Landis; Tiffany Ko; Ramani Balu; Sriram Balasubramanian; Alexis Topjian; Robert M Sutton; Robert A Berg; Todd J Kilbaugh Journal: Resusc Plus Date: 2020-12-05