We provide preliminary multicenter data to suggest that recruitment and collection of physiologic data necessary to quantify cerebral autoregulation and individualized blood pressure targets are feasible in postcardiac arrest patients. We evaluated the feasibility of a multicenter protocol to enroll patients across centers, as well as collect continuous recording (≥ 80% of monitoring time) of regional cerebral oxygenation and mean arterial pressure, which is required to quantify cerebral autoregulation, using the cerebral oximetry index, and individualized optimal mean arterial pressure thresholds. Additionally, we conducted an exploratory analysis to assess if an increased percentage of monitoring time where mean arterial pressure was greater than or equal to 5 mm Hg below optimal mean arterial pressure, percentage of monitoring time with dysfunctional cerebral autoregulation (i.e., cerebral oximetry index ≥ 0.3), and time to return of spontaneous circulation were associated with an unfavorable neurologic outcome (i.e., 6-mo Cerebral Performance Category score ≥ 3).
Design setting and patients: A prospective multicenter cohort study was conducted in ICUs in three teaching hospitals across Canada. Patients (≥ 16 yr old) were included if their cardiac arrest occurred within the previous 36 hours, they had greater than or equal to 20 consecutive minutes of spontaneous circulation following resuscitation, and they had a post-resuscitation Glasgow Coma Scale of less than or equal to 8.
Measurements and main results: Recruitment rates were calculated across sites, and patients underwent continuous regional cerebral oxygenation monitoring using near-infrared spectroscopy, as well as invasive blood pressure monitoring. Exploratory multivariable logistic regression was performed. Although it was feasible to recruit patients across multiple centers, there was variability in the recruitment rates. Physiologic data were captured in 86.2% of the total monitoring time and the median monitoring time was 47.5 hours (interquartile interval, 29.4-65.0 hr) across 59 patients. Specifically, 88% of mean arterial pressure and 96% of bilateral frontal regional cerebral oxygenation data were acquired, and 90% of cerebral oximetry index and 70% of optimal mean arterial pressure values were quantified. However, there was substantial variation in the amount of data captured among individuals. Time to return of spontaneous circulation was associated with an increased odds of an unfavorable neurologic outcome.
Conclusions and relevance: We demonstrated feasibility to recruit and collect high frequency physiologic data in patients after cardiac arrest. Future investigations will need to systematically document the reasons for data attrition, as well as how these methodological complications were resolved. Due to underpowered analyses and the inability to control for potential confounds, further studies are needed to explore the association between cerebral autoregulatory capacity and individualized mean arterial pressure thresholds with neurologic outcomes.
Keywords: cardiac arrest; cerebral autoregulation; hypoxic-ischemic brain injury; near-infrared spectroscopy; optimal mean arterial pressure.
Copyright © 2020 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the Society of Critical Care Medicine.