Deviations from NIRS-derived optimal blood pressure are associated with worse outcomes after pediatric cardiac arrest

Kirschen, Matthew; Majmudar, Tanmay; Beaulieu, Forrest; Burnett, Ryan; Shaik, Mohammed Ali; Morgan, Ryan W.; Ko, Tiffany; Balu, Ramani; Agarwal, Kenya; Lourie, Kristen; Sutton, Robert M.; Kilbaugh, Todd J.; Berg, Robert A.; Topjian, Alexis

doi:10.1016/j.resuscitation.2021.09.023

Cited by 34 publications

(15 citation statements)

References 48 publications

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“…405 Encouraging associations between NIRS measures and outcomes have also been observed. [400][401][402][403] After arrest, pilot studies have explored using NIRS to individualize blood pressure targets 406,407 as well as the use of DCS measures of CBF low-frequency power 408 and pulsatility as a neurologic biomarker. 409 Optical imaging also promises to provide valuable information in epilepsy monitoring.…”

Section: Critical Care Managementmentioning

confidence: 99%

Optical imaging and spectroscopy for the study of the human brain: status report

et al. 2022

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. This report is the second part of a comprehensive two-part series aimed at reviewing an extensive and diverse toolkit of novel methods to explore brain health and function. While the first report focused on neurophotonic tools mostly applicable to animal studies, here, we highlight optical spectroscopy and imaging methods relevant to noninvasive human brain studies. We outline current state-of-the-art technologies and software advances, explore the most recent impact of these technologies on neuroscience and clinical applications, identify the areas where innovation is needed, and provide an outlook for the future directions.

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Section: Critical Care Managementmentioning

confidence: 99%

Optical imaging and spectroscopy for the study of the human brain: status report

et al. 2022

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“…Clinical ECMO management uses age‐based MAP goals and weight‐based ECMO flow rates, 39 and MAP achieved is often discrepant from the optimal MAP required to maintain autoregulation. 42 As demonstrated in a recent ECPR swine model, a higher MAP target is beneficial to autoregulation during cardiac arrest yet detrimental after arrest. 33 The inability to maintain or control CBF after arrest is associated with worse neurological outcomes, 43 and while the heterogeneity in this study population, with average CBFs from 12% to 296% of baseline values during CPR and 7% to 139% during VA‐ECMO, limits conclusions that can be drawn, an inability to manage CBF attributable to deranged autoregulation likely contributed to injury and deserves further study.…”

Section: Discussionmentioning

confidence: 93%

Pediatric Extracorporeal Cardiopulmonary Resuscitation: Development of a Porcine Model and the Influence of Cardiopulmonary Resuscitation Duration on Brain Injury

Slovis

Volk

Mavroudis

et al. 2023

JAHA

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Background The primary objective was to develop a porcine model of prolonged (30 or 60 minutes) pediatric cardiopulmonary resuscitation (CPR) followed by 22‐ to 24‐hour survival with extracorporeal life support, and secondarily to evaluate differences in neurologic injury. Methods and Results Ten‐kilogram, 4‐week‐old female piglets were used. First, model development established the technique (n=8). Then, a pilot study was conducted (n=15). After 80% survival was achieved in the final 5 pilot animals, a proof‐of‐concept randomized study was completed (n=11). Shams (n=6) underwent anesthesia only. Severe neurological injury was determined by a composite score of mitochondrial function, neuropathology, and cerebral metabolism: scale of 0–6 (severe: >3). Among 15 piglets in the pilot study, overall survival was 10 (67%); of the final 5, overall survival was 4 (80%). Eleven piglets were then randomized to 60 (CPR60, n=5) or 30 minutes of CPR (CPR30, n=5); 1 animal was excluded from prerandomization for intra‐abdominal hemorrhage (10/11, 91% survival). Three of 5 animals in the CPR60 group had severe neurological injury scores versus 1 of 5 in the CPR30 group ( P =0.52). During ECMO, CPR60 animals had lower pH (CPR60: 7.4 [IQR 7.4–7.4] versus CPR30: 7.5 [IQR 7.4–7.5], P =0.022), higher lactate (CPR60: 6.8 [IQR 6.8–11] versus CPR30: 4.2 [IQR 4.1–4.3] mmol/L; P =0.012), and higher ICP (CPR60: 19.3 [IQR 11.7–29.3] versus CPR30: 7.9 [IQR 6.7–9.3] mm Hg; P =0.037). Both groups had greater mitochondrial injury than shams (CPR60: P <0.001; CPR30: P <0.001). CPR60 did not differ from CPR30 in mitochondrial respiration, neuropathology, or cerebral metabolism. Conclusions A pediatric porcine model of extracorporeal cardiopulmonary resuscitation after 60 and 30 minutes of CPR consistently resulted in 24‐hour survival with more severe lactic acidosis in the 60‐minute cohort.

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“…In these studies, higher TOx/COx values over the first 3 days is independently associated with an excess in mortality ( 220 ). Additionally several studies have demonstrated the feasibility of determining optimal MAP based on COx with evidence of a wide diversity of optimal thresholds across individuals, likely reflecting different cerebral injury patterns and impact of preexisting hypertension, with more favorable outcomes noted when the actual MAP more closely aligns with NIRS derived thresholds ( 219 , 221 , 222 ). These findings highlight the potential utility of NIRS technology to provide a foundation for non-invasive individualized hemodynamic management in patients with hypoxic ischemic brain injury.…”

Section: Near-infrared Spectroscopymentioning

confidence: 99%

Multimodal and autoregulation monitoring in the neurointensive care unit

2023

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Given the complexity of cerebral pathology in patients with acute brain injury, various neuromonitoring strategies have been developed to better appreciate physiologic relationships and potentially harmful derangements. There is ample evidence that bundling several neuromonitoring devices, termed “multimodal monitoring,” is more beneficial compared to monitoring individual parameters as each may capture different and complementary aspects of cerebral physiology to provide a comprehensive picture that can help guide management. Furthermore, each modality has specific strengths and limitations that depend largely on spatiotemporal characteristics and complexity of the signal acquired. In this review we focus on the common clinical neuromonitoring techniques including intracranial pressure, brain tissue oxygenation, transcranial doppler and near-infrared spectroscopy with a focus on how each modality can also provide useful information about cerebral autoregulation capacity. Finally, we discuss the current evidence in using these modalities to support clinical decision making as well as potential insights into the future of advanced cerebral homeostatic assessments including neurovascular coupling.

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Deviations from NIRS-derived optimal blood pressure are associated with worse outcomes after pediatric cardiac arrest

Cited by 34 publications

References 48 publications

Optical imaging and spectroscopy for the study of the human brain: status report

Optical imaging and spectroscopy for the study of the human brain: status report

Pediatric Extracorporeal Cardiopulmonary Resuscitation: Development of a Porcine Model and the Influence of Cardiopulmonary Resuscitation Duration on Brain Injury

Multimodal and autoregulation monitoring in the neurointensive care unit

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