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Association Between Cerebral Autoregulation and Outcome in Swine Model of Pediatric Cardiac Arrest
Journal article   Peer reviewed

Association Between Cerebral Autoregulation and Outcome in Swine Model of Pediatric Cardiac Arrest

Matthew Kirschen, Ryan Morgan, Tanmay Majmudar, William Landis, Tiffany Ko, Ramani Balu, Sriram Balasubramanian, Alexis Topjian, Robert Sutton, Robert Berg, …
Critical care medicine, v 49(1), pp 359-359
Jan 2021
DOI: https://doi.org/10.1097/01.ccm.0000728796.42850.af

Abstract

Introduction: During the post-cardiac arrest syndrome, impaired cerebrovascular autoregulation (CAR) leads to compromised cerebral perfusion and oxygen delivery. Our objectives were 1) to determine whether cerebral autoregulation (CAR) is intact during the first four hours after return of spontaneous circulation (ROSC) in a porcine model of pediatric cardiac arrest, and 2) to compare burden (dose) of CAR impairment when calculated using intracranial pressure (ICP) and a direct measure of cerebral blood flow (CBF). We hypothesize that CAR will be impaired after cardiac arrest and that the burden of impaired CAR will be associated with outcome. Methods: Four-week-old swine underwent 7 minutes of asphyxia followed by ventricular fibrillation induction and hemodynamic-directed CPR. Those achieving ROSC had arterial blood pressure, ICP, and CBF monitored for 4-hours. We calculated continuous, moving correlation coefficients between mean arterial pressure (MAP) and ICP (PRx), and MAP and CBF (CBFx). The burden of impaired CAR was calculated as the area under the PRx or CBFx curve using a threshold of 0.3 and normalized for monitoring duration. Based on 8-hour post-ROSC swine cerebral performance category (CPC) scores, animals were classified as normal (CPC 1) or abnormal (CPC 2-3). Differences between these outcome groups were compared using Wilcoxon rank-sum tests. Results: 23 animals who survived to 4 hours post-ROSC were included. Median PRx was 0.14 [0.06, 0.25] and CBFx was 0.36 [0.05, 0.44]. Median burden of impaired CAR was 21% [18, 27] with PRx and 30% [17, 40] with CBFx. 13 animals had a normal and 10 had an abnormal outcome. There were no differences between MAP (61.4±1.3 vs. 62.1±1.7 mmHg, p=0.69) or ICP (14.7±1.6 vs. 15.6±2.1 mmHg, p=0.67) between outcome groups, although there was a trend towards lower CBF in abnormal animals (241.5±53.2 vs. 372.4±70.8 PU, p=0.065). There was no difference in PRx burden between abnormal and normal animals (25% vs. 20%, p=0.376). However, CBFx burden was greater for abnormal animals (45% vs. 24%, p=0.001). Conclusions: CAR is impaired immediately after ROSC, and a greater burden of CAR impairment was associated with an abnormal neurologic outcome. CAR impairment was only demonstrated using a measure of microvascular CBF, and not when using ICP.

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