An observational near-infrared spectroscopy study on cerebral autoregulation in post-cardiac arrest patients: time to drop 'one-size-fits-all' hemodynamic targets?

Resuscitation
K AmelootC DeDeyne

Abstract

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. Prospective observational study in 51 post-CA patients monitored with near infrared spectroscopy. (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 pa...Continue Reading

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Citations

Jan 24, 2016·Resuscitation·J P NolanJ Soar
Dec 17, 2015·Best Practice & Research. Clinical Anaesthesiology·Tommaso PellisGiuseppe Ristagno
Apr 23, 2016·Therapeutic Hypothermia and Temperature Management·Ediz TasanCharles L Campbell
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Oct 28, 2021·Intensive Care Medicine·Claudio SandroniMypinder Sekhon

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