Abstract
Aim
We evaluated the association of physiological parameters measured by intracranial
multimodality neuromonitoring with neurologic outcome in a consecutive series of patients
with hypoxic-ischemic brain injury (HIBI).
Methods
We retrospectively identified all patients with HIBI who underwent combined invasive
intracranial pressure (ICP) and brain tissue oxygen (PbtO2) monitoring over a 3 year period. Cerebrovascular pressure reactivity index (PRx)
was calculated continuously as a surrogate of cerebral autoregulation. Favorable outcome
was defined as recovery of consciousness (Glasgow Coma Scale motor score = 6). Differences
in mean ICP, PRx and PbtO2 for the entire monitoring period across outcomes were measured. Logistic regression
and area under receiver operating characteristic (AUROC) curve were used to assess
the association of each monitoring parameter with neurologic outcome.
Results
We analyzed data from 36 patients. Most (89%) had an antecedent sudden cardiac arrest.
Favorable outcome occurred in 8 (22%) patients. ICP and PRx were higher in patients
with unfavorable outcome (ICP: 26 ± 4.1 mmHg vs 7.5 ± 2 mmHg, p = 0.0002; PRx: 0.51 ± 0.05
vs 0.11 ± 0.05, p < 0.0001). There was no significant difference in PbtO2 between groups (unfavorable: 20 ± 2.4 mmHg vs favorable: 25 ± 1.5 mmHg, p = 0.12).
Both ICP (AUROC 0.84, 95%CI 0.72–0.98, p = 0.003) and PRx (AUROC 0.94, 95%CI 0.85–1,
p = 0.0002) discriminated between favorable and unfavorable outcome, in contrast to
PbtO2, (AUROC 0.59, 95%CI 0.39–0.78, p = 0.52). ICP > 15 mmHg, PRx > 0.2, and PbtO2 < 18 mmHg had sensitivity/specificity of 68%/100%, 89%/88%, and 40%/100% respectively
for discriminating outcomes.
Conclusion
Cerebrovascular pressure reactivity and intracranial pressure appear to be associated
with neurologic outcome in patients with HIBI.
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
- Heart disease and stroke statistics-2019 update: a report from the American Heart Association.Circulation. 2019; 139: e56-e528
- Association of early withdrawal of life-sustaining therapy for perceived neurological prognosis with mortality after cardiac arrest.Resuscitation. 2016; 102: 127-135
- Intensive care unit mortality after cardiac arrest: the relative contribution of shock and brain injury in a large cohort.Intensive Care Med. 2013; 39: 1972-1980
- Clinical pathophysiology of hypoxic ischemic brain injury after cardiac arrest: a “two-hit” model.Crit Care. 2017; 21: 90
- Brain blood flow and metabolism after global ischemia and post-insult thiopental therapy in monkeys.Stroke. 1979; 10: 554-560
- Global ischemia in dogs: intracranial pressures, brain blood flow and metabolism.Stroke. 1975; 6: 21-27
- Guidelines for the management of severe traumatic brain injury, fourth edition.Neurosurgery. 2017; 80: 6-15
- Consensus summary statement of the international multidisciplinary consensus conference on multimodality monitoring in neurocritical care: a statement for healthcare professionals from the Neurocritical Care Society and the European Society of Intensive Care Medicine.Intensive Care Med. 2014; 40: 1189-1209
- Association of brain metabolites with blood lactate and glucose levels with respect to neurological outcomes after out-of-hospital cardiac arrest: a preliminary microdialysis study.Resuscitation. 2017; 110: 26-31
- Relationship between time related serum albumin concentration, optic nerve sheath diameter, cerebrospinal fluid pressure, and neurological prognosis in cardiac arrest survivors.Resuscitation. 2018; 131: 42-47
- Prognostic significance of early intracranial and cerebral perfusion pressures in post-cardiac arrest anoxic coma.Intensive Care Med. 1991; 17: 392-398
- Intracranial pressure and compliance in hypoxic ischemic brain injury patients after cardiac arrest.Resuscitation. 2019; 141: 96-103
- The burden of brain hypoxia and optimal mean arterial pressure in patients with hypoxic ischemic brain injury after cardiac arrest.Crit Care Med. 2019; 47: 960-969
- Goal-directed care using invasive neuromonitoring versus standard of care after cardiac arrest: a matched cohort study.Crit Care Med. 2021; (Online ahead of print)
- Brain oxygen optimization in severe traumatic brain injury phase-II: a phase II randomized trial.Crit Care Med. 2017; 45: 1907-1914
- Anemia and brain oxygen after severe traumatic brain injury.Intensive Care Med. 2012; 38: 1497-1504
- The effect of packed red blood cell transfusion on cerebral oxygenation and metabolism after subarachnoid hemorrhage.Neurocrit Care. 2016; 24: 118-121
- Packed red blood cell transfusion increases local cerebral oxygenation.Crit Care Med. 2005; 33: 1104-1108
- Continuous determination of optimal cerebral perfusion pressure in traumatic brain injury.Crit Care Med. 2012; 40: 2456-2463
- Continuous assessment of the cerebral vasomotor reactivity in head injury.Neurosurgery. 1997; 41 (discussion 7-9): 11-17
- Continuous monitoring of cerebrovascular pressure reactivity allows determination of optimal cerebral perfusion pressure in patients with traumatic brain injury.Crit Care Med. 2002; 30: 733-738
- A method of comparing the areas under receiver operating characteristic curves derived from the same cases.Radiology. 1983; 148: 839-843
- Safety and reliability of bedside, single burr hole technique for intracranial multimodality monitoring in severe traumatic brain injury.Neurocrit Care. 2018; 29: 469-480
- Intracranial multimodal monitoring for acute brain injury: a single institution review of current practices.Neurocrit Care. 2010; 12: 188-198
- Combined continuous monitoring of systemic and cerebral oxygen metabolism after cardiac arrest.Resuscitation. 1995; 29: 189-194
- Characteristics of jugular bulb oxygen saturation in patients after cardiac arrest: a prospective study.Acta Anaesthesiol Scand. 2018; 62: 1237-1245
- Critical thresholds for cerebrovascular reactivity after traumatic brain injury.Neurocrit Care. 2012; 16: 258-266
- Association between cerebrovascular reactivity monitoring and mortality is preserved when adjusting for baseline admission characteristics in adult TBI: a CENTER-TBI study.J Neurotrauma. 2019; 37: 1233-1241
- 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
- Continuous non-invasive optical monitoring of cerebral blood flow and oxidative metabolism after acute brain injury.J Cereb Blood Flow Metab. 2019; 39: 1469-1485
- Dynamic autoregulation of cerebral blood flow measured non-invasively with fast diffuse correlation spectroscopy.J Cereb Blood Flow Metab. 2018; 38: 230-240
- Are changes in cerebrovascular autoregulation following cardiac arrest associated with neurological outcome? Results of a pilot study.Resuscitation. 2015; 96: 192-198
- Validation of near-infrared spectroscopy for monitoring cerebral autoregulation in comatose patients.Neurocrit Care. 2017; 27: 362-369
- Near-infrared spectroscopy-derived cerebral autoregulation indices independently predict clinical outcome in acutely ill comatose patients.J Neurosurg Anesthesiol. 2019; 32: 234-241
- Using the relationship between brain tissue regional saturation of oxygen and mean arterial pressure to determine the optimal mean arterial pressure in patients following cardiac arrest: a pilot proof-of-concept study.Resuscitation. 2016; 106: 120-125
Article info
Publication history
Published online: April 27, 2021
Accepted:
April 20,
2021
Received in revised form:
April 9,
2021
Received:
December 21,
2019
Identification
Copyright
© 2021 Elsevier B.V. All rights reserved.
