Supporting the circulation, but injuring the brain: the (still unsolved) threat and paradox of extracorporeal life support

Lorusso, Roberto; Bělohlávek, Jan

doi:10.1177/0267659120909080

Cited by 2 publications

(4 citation statements)

References 14 publications

(23 reference statements)

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“…The goal of initial trauma resuscitation should be to rescue the cardiopulmonary system but while doing so, preserve and protect the central nervous system. Cerebral perfusion is an important resuscitation endpoint to assess the neurological status of survivors ( van den Brule et al, 2018 ; Lorusso and Bělohlávek, 2020 ; Gil-Anton et al, 2020 ). Computed tomography perfusion (CTP) scanning offers a non-invasive method to assess for cerebral perfusion ( Abdou et al, 2021 ; Abdou et al, 2022 ).…”

Section: Introductionmentioning

confidence: 99%

Characterization of cerebral blood flow during open cardiac massage in swine: Effect of volume status

et al. 2022

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Introduction: Patients in cardiac arrest treated with resuscitative thoracotomy and open cardiac massage (OCM) have high rates of mortality with poor neurological outcomes. The aim of this study is to quantitate cerebral perfusion during OCM using computed tomography perfusion (CTP) imaging in a swine model of normo- and hypovolemia.Methods: Anesthetized swine underwent instrumentation with right atrial and aortic pressure catheters. A catheter placed in the ascending aorta was used to administer iodinated contrast and CTP imaging acquired. Cerebral blood flow (CBF; ml/100 g of brain) and time to peak (TTP; s) were measured. Animals were then euthanized by exsanguination (hypovolemic group) or potassium chloride injection (normovolemic group) and subjected to a clamshell thoracotomy, aortic cross clamping, OCM, and repeated CTP. Data pertaining to peak coronary perfusion pressure (pCoPP; mmHg) were collected and % CoPP > 15 mmHg (% CoPP; s) calculated post hoc.Results: Normovolemic animals (n = 5) achieved superior pCoPP compared to the hypovolemic animals (n = 5) pCoPP (39.3 vs. 12.3, p < 0.001) and % CoPP (14.5 ± 1.9 vs. 30.9 ± 6.5, p < 0.001). CTP acquisition was successful and TTP elongated from spontaneous circulation, normovolemia to hypovolemia (5.7 vs. 10.8 vs. 14.8, p = 0.01). CBF during OCM was similar between hypovolemic and normovolemic groups (7.5 ± 8.1 vs. 4.9 ± 6.0, p = 0.73) which was significantly lower than baseline values (51.9 ± 12.1, p < 0.001).Conclusion: OCM in normovolemia generates superior coronary hemodynamics compared to hypovolemia. Despite this, neither generates adequate CBF as measured by CTP, compared to baseline. To improve the rate of neurologically intact survivors, novel resuscitative techniques need to be investigated that specifically target cerebral perfusion as existing techniques are inadequate.

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Section: Introductionmentioning

confidence: 99%

Characterization of cerebral blood flow during open cardiac massage in swine: Effect of volume status

et al. 2022

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“…This would potentially reduce contrast volume and improve resolving power. The aim of this study was to (1) identify an intra-arterial (IA) contrast bolus dose and timing that is suitable for intra-arterial computed tomography perfusion (IA-CTP) use, (2) to demonstrate reproducibility of IA-CTP and correlate with intracranial LASER Doppler flow (LDF) measurements, and (3) to use IA-CTP to quantify brain perfusion in the setting of hypotension and periarrested states secondary to hemorrhage.…”

mentioning

confidence: 99%

“…C erebral perfusion is of critical importance during acute resuscitative efforts to have neurologically intact survivors. 1,2 This applies during cardiac arrest and hemorrhagic shock. In the setting of hemorrhage, the focus of treatment is often on the circulatory system with the use of pressors and resuscitative fluid.…”

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Development of a computed tomography perfusion protocol to support large animal resuscitation research

Abdou

Elansary²,

Poliner³

et al. 2021

J Trauma Acute Care Surg

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BACKGROUND: Adequate cerebral perfusion is crucial for a positive neurological outcome in trauma; however, it is difficult to characterize in the acute setting with noninvasive methods. Intra-arterial computed tomography perfusion may offer a solution. The aim of this study was to develop an intra-arterial computed tomography perfusion protocol for resuscitation research. METHODS:The study examined intra-arterial contrast administration for computed tomography perfusion (CTP) acquisition. It consisted of three phases: intra-arterial contrast dose finding, evaluation of reproducibility, and evaluation during hypotension. Blood pressure and laser Doppler flow data were collected. In phase 1, animals underwent CTPs using several intra-arterial contrast injection protocols. In phase 2, animals underwent two CTPs 7 hours apart using the 2.5 mL/s for 3-second protocol. In phase 3, animals underwent CTPs at several pressures following a computer-controlled bleed including euvolemia and at systolic pressures of 60, 40, and 20 mm Hg. Phase 1 CTPs were evaluated for contrast-to-noise ratio. In phase 2, CTPs were compared within each animal and with laser Doppler flow using linear regression. Phase 3 CTPs were graphed against systolic pressure and fitted with a nonlinear fit. RESULTS:The protocol using 2.5mL/s for 3 seconds was optimal, demonstrating a contrast-to-noise ratio of 40.1 and a superior arterial input function curve compared with the 1 mL/s bolus. Cerebral blood flow demonstrated high concordance between baseline and end of study CTPs (R 2 = 0.82, p < 0.001). Cerebral blood flow also compared moderately well against laser Doppler flow during 8 (R 2 = 0.53, p = 0.03); however, laser Doppler flow did not perform well during hypovolemia, and the favorable concordance was not maintained (R 2 = 0.45, p = 0.06).Cerebral blood flow was graphed against systolic blood pressure and fitted with a nonlinear fit (R 2 = 0.95, p = 0.003). CONCLUSION: Computed tomography perfusion using intra-arterial contrast injection may offer a novel alternative to traditional CTP protocols that could prove a useful additional tool in the setting of resuscitation research.

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Supporting the circulation, but injuring the brain: the (still unsolved) threat and paradox of extracorporeal life support

Cited by 2 publications

References 14 publications

Characterization of cerebral blood flow during open cardiac massage in swine: Effect of volume status

Characterization of cerebral blood flow during open cardiac massage in swine: Effect of volume status

Development of a computed tomography perfusion protocol to support large animal resuscitation research

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