Are changes in cerebrovascular autoregulation following cardiac arrest associated with neurological outcome? Results of a pilot study

Paul Pham, Jessica Bindra, Alwin Chuan, Matthias Jaeger, Anders Aneman*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

33 Citations (Scopus)

Abstract

Purpose: To investigate the association between impaired cerebrovascular autoregulation (CVAR) and outcome in comatose survivors of cardiac arrest. Methods: The correlation in the time domain between cerebral tissue oxygenation (cStO2) using near infrared spectroscopy (NIRS) and mean arterial pressure was used to determine the tissue oxygenation index (TOx) as a reflection of normal (TOx<0) or impaired (TOx>0) CVAR. Daily measurements (>1h recording time) were performed in the first three days post cardiac arrest. Survival and neurological outcome was assessed at three months following cardiac arrest. A control group of healthy volunteers was also investigated. Results: 23 patients and 28 volunteers were studied. All survivors (n=8) of cardiac arrest had a good neurological outcome. The TOx (median [interquartile range] for days 1-3) was higher (Mann Whitney test, p<0.001) in non-survivors (0.04 [-0.02 to -0.16]) compared to survivors (-0.11 [-0.19 to -0.02]) and healthy volunteers (-0.15 [-0.27 to -0.04]) on every day and for days 1-3 following cardiac arrest. The TOx was not significantly different between survivors and healthy volunteers. The cStO2 did not discriminate survivors (67 [62-72]%) from non-survivors (71 [65-75]%). Logistic regression analysis demonstrated TOx to be independently associated with survival at three months post cardiac arrest (odds ratio [95% confidence interval] 0.01 [0.01-0.50], p=0.04). Conclusions: Early impairment of CVAR following cardiac arrest is independently associated with mortality at three months follow-up. Assessments of CVAR could add to the management and prognostication during post-resuscitation care and should be further investigated as a guide to optimise cerebral perfusion pressure.

Original languageEnglish
Pages (from-to)192-198
Number of pages7
JournalResuscitation
Volume96
DOIs
Publication statusPublished - 1 Nov 2015
Externally publishedYes

Keywords

  • Cardiac arrest
  • Cerebrovascular circulation
  • Near infrared spectroscopy
  • Outcome

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