Optimal oxygen and mean arterial blood pressure targets after cardiac arrest

Skrifvars, Markus B.; Bray, Janet; Hassager, Christian

doi:10.1007/s00134-023-07018-7

Cited by 3 publications

(1 citation statement)

References 15 publications

(17 reference statements)

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“…Another notable nding is we identi ed individualized optimal perfusion pressures for all patients and found the median optimal MAP to be 75 mmHg, which is 10 mmHg higher than perfusion targets recommended by current guidelines. 32,33 Existing studies on CA after cardiac arrest have published similar ndings, and the utility of adopting personalized perfusion goals on reducing acute brain injury or improving neurologic outcomes should be examined in future research. 26,34 Limitations Our pilot study is exploratory in nature, limited by a small sample size and cohort heterogeneity.…”

Section: Discussionmentioning

confidence: 96%

Continuous Monitoring of Cerebral Autoregulation in Adults Supported by Extracorporeal Membrane Oxygenation

Zhang,

Chang,

Kalra

et al. 2024

Neurocrit Care

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Background: Impaired cerebral autoregulation (CA) is one of several proposed mechanisms of acute brain injury in patients supported by extracorporeal membrane oxygenation (ECMO). The primary aim of this study was to determine the feasibility of continuous CA monitoring in adult ECMO patients. Our secondary aims were to describe changes in cerebral oximetry index (COx) and other metrics of CA over time and in relation to functional neurologic outcomes.Methods: This is a single-center prospective observational study. We measured Cox, a surrogate measurement of cerebral blood ow, measured by near-infrared spectroscopy, which is an index of CA derived from the moving correlation between mean arterial pressure and slow waves of regional cerebral oxygen saturation. A COx value that approaches 1 indicates impaired CA. Using COx, we determined the optimal MAP (MAP OPT ), lower and upper limits of autoregulation for individual patients. These measurements were examined in relation to modi ed Rankin Scale (mRS) scores.Results: Fifteen patients (median age=57 years [IQR=47-69]) with 150 autoregulation measurements were included for analysis. Eleven were on veno-arterial ECMO and 4 on veno-venous. Mean COx was higher on post-cannulation day 1 than on day 2 (0.2 vs 0.09, p<0.01), indicating improved CA over time. COx was higher in VA-ECMO patients than in VV-ECMO (0.12 vs 0.06, p=0.04). Median MAP OPT for entire cohort was highly variable, ranging 55-110 mmHg. Patients with mRS 0-3 (good outcome) at 3 and 6 months spent less time outside of MAP OPT compared to patients with mRS 4-6 (poor outcome) (74% vs 82%, p=0.01). The percentage of time when observed MAP was outside the limits of autoregulation was higher on post-cannulation day 1 than on day 2 (18.2% vs 3.3%, p<0.01).Conclusions: In ECMO patients, it is feasible to monitor CA continuously at the bedside. CA improved over time, most signi cantly between post-cannulation days 1 and 2. CA was more impaired in VA-ECMO than VV-ECMO. Spending less time outside of MAP OPT may be associated with achieving a good neurologic outcome.

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Section: Discussionmentioning

confidence: 96%

Continuous Monitoring of Cerebral Autoregulation in Adults Supported by Extracorporeal Membrane Oxygenation

Zhang,

Chang,

Kalra

et al. 2024

Neurocrit Care

View full text Add to dashboard Cite

show abstract

Where have all the kidneys gone? After ECPR, they are here to stay

Drábek

2023

Resuscitation

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Continuous Monitoring of Cerebral Autoregulation in Adults Supported by Extracorporeal Membrane Oxygenation

Zhang,

Chang,

Kalra

et al. 2023

Preprint

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Background: Impaired cerebral autoregulation (CA) is one of several proposed mechanisms of acute brain injury in patients supported by extracorporeal membrane oxygenation (ECMO). The primary aim of this study was to determine the feasibility of continuous CA monitoring in adult ECMO patients. Our secondary aims were to describe changes in cerebral oximetry index (COx) and other metrics of CA over time and in relation to functional neurologic outcomes. Methods: This is a single-center prospective observational study. We measured Cox, a surrogate measurement of cerebral blood flow, measured by near-infrared spectroscopy, which is an index of CA derived from the moving correlation between mean arterial pressure and slow waves of regional cerebral oxygen saturation. A COx value that approaches 1 indicates impaired CA. Using COx, we determined the optimal MAP (MAPOPT), lower and upper limits of autoregulation for individual patients. These measurements were examined in relation to modified Rankin Scale (mRS) scores. Results: Fifteen patients (median age=57 years [IQR=47-69]) with 150 autoregulation measurements were included for analysis. Eleven were on veno-arterial ECMO and 4 on veno-venous. Mean COx was higher on post-cannulation day 1 than on day 2 (0.2 vs 0.09, p<0.01), indicating improved CA over time. COx was higher in VA-ECMO patients than in VV-ECMO (0.12 vs 0.06, p=0.04). Median MAPOPT for entire cohort was highly variable, ranging 55-110 mmHg. Patients with mRS 0-3 (good outcome) at 3 and 6 months spent less time outside of MAPOPT compared to patients with mRS 4-6 (poor outcome) (74% vs 82%, p=0.01). The percentage of time when observed MAP was outside the limits of autoregulation was higher on post-cannulation day 1 than on day 2 (18.2% vs 3.3%, p<0.01). Conclusions: In ECMO patients, it is feasible to monitor CA continuously at the bedside. CA improved over time, most significantly between post-cannulation days 1 and 2. CA was more impaired in VA-ECMO than VV-ECMO. Spending less time outside of MAPOPT may be associated with achieving a good neurologic outcome.

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Optimal oxygen and mean arterial blood pressure targets after cardiac arrest

Cited by 3 publications

References 15 publications

Continuous Monitoring of Cerebral Autoregulation in Adults Supported by Extracorporeal Membrane Oxygenation

Continuous Monitoring of Cerebral Autoregulation in Adults Supported by Extracorporeal Membrane Oxygenation

Where have all the kidneys gone? After ECPR, they are here to stay

Continuous Monitoring of Cerebral Autoregulation in Adults Supported by Extracorporeal Membrane Oxygenation

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