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Journal article
The association between early impairment in cerebral autoregulation and outcome in a pediatric swine model of cardiac arrest
Resuscitation plus, v 4, 100051
01 Dec 2020
PMID: 34223325
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
Aims: Evaluate cerebral autoregulation (CAR) by intracranial pressure reactivity index (PRx) and cerebral blood flow reactivity index (CBFx) during the first four hours following return of spontaneous circulation (ROSC) in a porcine model of pediatric cardiac arrest. Determine whether impaired CAR is associated with neurologic outcome.
Methods: Four-week-old swine underwent seven minutes of asphyxia followed by ventricular fibrillation induction and hemodynamic-directed CPR. Those achieving ROSC had arterial blood pressure, intracranial pressure (ICP), and microvascular cerebral blood flow (CBF) monitored for 4h. Animals were assigned an 8-h post-ROSC swine cerebral performance category score (1= normal; 2-4=abnormal neurologic function). In this secondary analytic study, we calculated PRx and CBFx using a continuous, moving correlation coefficient between mean arterial pressure (MAP) and ICP, and between MAP and CBF, respectively. Burden of impaired CAR was the area under the PRx or CBFx curve using a threshold of 0.3 and normalized as percentage of monitoring duration.
Results: Among 23 animals, 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. Neurologically abnormal animals (n= 10) did not differ from normal animals (n=13) in post-ROSC MAP (63 vs. 61 mmHg, p=0.74), ICP (15 vs. 14mmHg, p= 0.78) or CBF (274 vs. 397 Perfusion Units, p= 0.12). CBFx burden was greater among abnormal than normal animals (45% vs. 24%, p=0.001), but PRx burden was not (25% vs. 20%, p=0.38).
Conclusion: CAR is impaired early after ROSC. A greater burden of CAR impairment measured by CBFx was associated with abnormal neurologic outcome.
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Details
- Title
- The association between early impairment in cerebral autoregulation and outcome in a pediatric swine model of cardiac arrest
- Creators
- Matthew P. Kirschen - Children's Hospital of PhiladelphiaRyan W. Morgan - Children's Hospital of PhiladelphiaTanmay Majmudar - Drexel UniversityWilliam P. Landis - Children's Hospital of PhiladelphiaTiffany Ko - Children's Hospital of PhiladelphiaRamani Balu - University of PennsylvaniaSriram Balasubramanian - Drexel UniversityAlexis Topjian - Children's Hospital of PhiladelphiaRobert M. Sutton - Children's Hospital of PhiladelphiaRobert A. Berg - Children's Hospital of PhiladelphiaTodd J. Kilbaugh - Children's Hospital of Philadelphia
- Publication Details
- Resuscitation plus, v 4, 100051
- Publisher
- Elsevier
- Number of pages
- 7
- Grant note
- K23HL148541; R01HL141386 / NIH NHLBI; United States Department of Health & Human Services; National Institutes of Health (NIH) - USA; NIH National Heart Lung & Blood Institute (NHLBI)
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- College of Medicine; School of Biomedical Engineering, Science, and Health Systems
- Web of Science ID
- WOS:000675511000026
- Scopus ID
- 2-s2.0-85116072405
- Other Identifier
- 991019167446304721
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- Collaboration types
- Domestic collaboration
- Web of Science research areas
- Critical Care Medicine
- Emergency Medicine