Cerebrovascular autoregulation following cardiac arrest: protocol for a post hoc analysis of the randomised COMACARE pilot trial

Anders Aneman, Johanna Laurikalla, Paul Pham, Erika Wilkman, Pekka Jakkula, Matti Reinikainen, Jussi Toppila, Markus B. Skrifvars

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Background: Approximately two-thirds of the mortality following out of hospital cardiac arrest is related to devastating neurological injury. Previous small cohort studies have reported an impaired cerebrovascular autoregulation following cardiac arrest, but no studies have assessed the impact of differences in oxygen and carbon dioxide tensions in addition to mean arterial pressure management. Methods: This is a protocol and statistical analysis plan to assess the correlation between changes in cerebral tissue oxygenation and arterial pressure as measure of cerebrovascular autoregulation, the tissue oxygenation index, in patients following out of hospital cardiac arrest and in healthy volunteers. The COMACARE study included 120 comatose survivors of out of hospital cardiac arrest admitted to ICU and managed with low-normal or high-normal targets for mean arterial pressure, arterial oxygen and carbon dioxide partial pressures. In addition, 102 healthy volunteers have been investigated as a reference group for the tissue oxygenation index. In both cohorts, the cerebral tissue oxygenation was measured by near infrared spectroscopy. Conclusions: Cerebrovascular autoregulation is critical to maintain homoeostatic brain perfusion. This study of changes in autoregulation following out of hospital cardiac arrest over the first 48 hours, as compared to data from healthy volunteers, will generate important physiological information that may guide the rationale and design of interventional studies.

LanguageEnglish
Pages1272-1277
Number of pages6
JournalActa Anaesthesiologica Scandinavica
Volume63
Issue number9
Early online date8 Jul 2019
DOIs
Publication statusPublished - Oct 2019

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Out-of-Hospital Cardiac Arrest
Heart Arrest
Homeostasis
Healthy Volunteers
Arterial Pressure
Carbon Dioxide
Oxygen
Near-Infrared Spectroscopy
Partial Pressure
Coma
Survivors
Cohort Studies
Perfusion
Mortality
Wounds and Injuries
Brain

Cite this

Aneman, A., Laurikalla, J., Pham, P., Wilkman, E., Jakkula, P., Reinikainen, M., ... Skrifvars, M. B. (2019). Cerebrovascular autoregulation following cardiac arrest: protocol for a post hoc analysis of the randomised COMACARE pilot trial. Acta Anaesthesiologica Scandinavica, 63(9), 1272-1277. https://doi.org/10.1111/aas.13435
Aneman, Anders ; Laurikalla, Johanna ; Pham, Paul ; Wilkman, Erika ; Jakkula, Pekka ; Reinikainen, Matti ; Toppila, Jussi ; Skrifvars, Markus B. / Cerebrovascular autoregulation following cardiac arrest : protocol for a post hoc analysis of the randomised COMACARE pilot trial. In: Acta Anaesthesiologica Scandinavica. 2019 ; Vol. 63, No. 9. pp. 1272-1277.
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Aneman, A, Laurikalla, J, Pham, P, Wilkman, E, Jakkula, P, Reinikainen, M, Toppila, J & Skrifvars, MB 2019, 'Cerebrovascular autoregulation following cardiac arrest: protocol for a post hoc analysis of the randomised COMACARE pilot trial', Acta Anaesthesiologica Scandinavica, vol. 63, no. 9, pp. 1272-1277. https://doi.org/10.1111/aas.13435

Cerebrovascular autoregulation following cardiac arrest : protocol for a post hoc analysis of the randomised COMACARE pilot trial. / Aneman, Anders; Laurikalla, Johanna; Pham, Paul; Wilkman, Erika; Jakkula, Pekka; Reinikainen, Matti; Toppila, Jussi; Skrifvars, Markus B.

In: Acta Anaesthesiologica Scandinavica, Vol. 63, No. 9, 10.2019, p. 1272-1277.

Research output: Contribution to journalArticleResearchpeer-review

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T1 - Cerebrovascular autoregulation following cardiac arrest

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AU - Aneman, Anders

AU - Laurikalla, Johanna

AU - Pham, Paul

AU - Wilkman, Erika

AU - Jakkula, Pekka

AU - Reinikainen, Matti

AU - Toppila, Jussi

AU - Skrifvars, Markus B.

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N2 - Background: Approximately two-thirds of the mortality following out of hospital cardiac arrest is related to devastating neurological injury. Previous small cohort studies have reported an impaired cerebrovascular autoregulation following cardiac arrest, but no studies have assessed the impact of differences in oxygen and carbon dioxide tensions in addition to mean arterial pressure management. Methods: This is a protocol and statistical analysis plan to assess the correlation between changes in cerebral tissue oxygenation and arterial pressure as measure of cerebrovascular autoregulation, the tissue oxygenation index, in patients following out of hospital cardiac arrest and in healthy volunteers. The COMACARE study included 120 comatose survivors of out of hospital cardiac arrest admitted to ICU and managed with low-normal or high-normal targets for mean arterial pressure, arterial oxygen and carbon dioxide partial pressures. In addition, 102 healthy volunteers have been investigated as a reference group for the tissue oxygenation index. In both cohorts, the cerebral tissue oxygenation was measured by near infrared spectroscopy. Conclusions: Cerebrovascular autoregulation is critical to maintain homoeostatic brain perfusion. This study of changes in autoregulation following out of hospital cardiac arrest over the first 48 hours, as compared to data from healthy volunteers, will generate important physiological information that may guide the rationale and design of interventional studies.

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