Abstract
Aim
To describe the cerebral blood flow velocity pattern and investigate cerebral autoregulation
using transcranial Doppler ultrasonography (TCD) following a global hypoxic-ischaemic
(HI) event in children.
Methods
This was a prospective, observational study in a quaternary-level paediatric intensive
care unit. Intubated children, newborn to 17 years admitted to the PICU following
HI injury (asphyxia, drowning, cardiac arrest) were eligible for inclusion. TCD was
performed daily until post-injury day 8, discharge, or death, whichever occurred earliest.
Results
Twenty-six patients were enrolled. Median age was 3 years (0.33, 11.75), initial pH
6.95, and initial lactate 5.4. Median post-resuscitation Glasgow Coma Score was 3T.
Across the entire cohort, cerebral blood flow velocity (CBFV) was near normal on day
1. Flow velocity increased to a maximum median value of 1.4 standard deviations above
normal on day 3 and slowly downtrended back to baseline by the end of the study period.
Median Paediatric Extended Version of the Glasgow Outcome Score was 4 at three months.
No patient in the favourable outcome group had extreme CBFV on day one, and only one
patient in the favourable group had extreme CBFV on PID 2. In contrast, 38% of patients
in the unfavourable group had extreme CBFV on PID 1 (p=.039 compared to frequency
in favourable group), and 55% had extreme CBFV on PID 2 (p = .023 compared to frequency
in favourable group). No patient had consistently intact cerebral autoregulation throughout
the study period.
Conclusions
Following a HI event, patients with favourable neurologic outcomes had flow velocity
near normal whereas unfavourable outcomes had more extreme flow velocity. Intermittently
intact cerebral autoregulation was more frequently seen in those with favourable neurologic
outcomes though return to the autoregulatory baseline appears delayed.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to ResuscitationAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Time to epinephrine and survival after pediatric in-hospital cardiac arrest.JAMA. 2015; 314: 802-810
- Trends in US pediatric drowning hospitalizations, 1993–2008.Pediatrics. 2012; 129: 275-281
- Pediatric out-of-hospital cardiac arrest characteristics and their association with survival and neurobehavioral outcome.Pediatr Crit Care Med. 2016; 17: e543-e550
- Noninvasive transcranial Doppler ultrasound recording of flow velocity in basal cerebral arteries.J Neurosurg. 1982; 57: 769-774
- Transcranial Doppler sonography in pediatric neurocritical care: a review of clinical applications and case illustrations in the pediatric intensive care unit.J Ultrasound Med. 2015; 34: 2121-2132
- Current opinion and use of transcranial Doppler ultrasonography in traumatic brain injury in the pediatric intensive care unit.J Neurotrauma. 2016; 33: 2105-2114
- Role of transcranial Doppler in neurocritical care.Crit Care Med. 2007; 35: S216-23
- Use of transcranial Doppler ultrasound in the management of post-cardiac arrest syndrome.Resuscitation. 2009; 80: 1321-1322
- A pilot study of cerebrovascular reactivity autoregulation after pediatric cardiac arrest.Resuscitation. 2014; 85: 1387-1393
- An observational near-infrared spectroscopy study on cerebral autoregulation in post-cardiac arrest patients: time to drop ‘one-size-fits-all' hemodynamic targets?.Resuscitation. 2015; 90: 121-126
- A bedside test for cerebral autoregulation using transcranial Doppler ultrasound.Acta Neurochirurgica. 1991; 108: 7-14
- Assessment of cerebral autoregulation using carotid artery compression.Stroke J Cereb Circ. 1996; 27: 2197-2203
- Evaluation of the transient hyperemic response test in head-injured patients.J Neurosurg. 1997; 86: 773-778
- Validity of a pediatric version of the Glasgow Outcome Scale-Extended.J Neurotrauma. 2012; 29: 1126-1139
- Reference values for cerebral blood flow velocities in critically ill, sedated children.Childs Nerv Syst. 2015; 31: 2269-2276
- Analysis of the evidence for the lower limit of systolic and mean arterial pressure in children.Pediatr Crit Care Med. 2007; 8: 138-144
- Middle cerebral artery flow, the critical closing pressure, and the optimal mean arterial pressure in comatose cardiac arrest survivors-an observational study.Resuscitation. 2017; 110: 85-89
- Duplex sonography of cerebral blood flow after cardiac arrest-a prospective observational study.Resuscitation. 2014; 85: 516-521
- Dynamic cerebral autoregulation in healthy adolescents.Acta Anaesthesiol Scand. 2002; 46: 393-397
- Are changes in cerebrovascular autoregulation following cardiac arrest associated with neurological outcome: results of a pilot study.Resuscitation. 2015; 96: 192-198
Article info
Publication history
Published online: February 13, 2018
Accepted:
February 5,
2018
Received in revised form:
October 27,
2017
Received:
August 6,
2017
Identification
Copyright
© 2018 Elsevier B.V. All rights reserved.
