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Invasive neuromonitoring post-cardiac arrest: Key considerations

  • Ryan L. Hoiland
    Affiliations
    Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver, BC, Canada

    Centre for Heart, Lung, & Vascular Health, School of Health and Exercise Sciences, University of British Columbia – Okanagan, Kelowna, BC, Canada
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  • Donald E. Griesdale
    Affiliations
    Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver, BC, Canada

    Division of Critical Care Medicine, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
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  • Mypinder S. Sekhon
    Correspondence
    Corresponding author.
    Affiliations
    Division of Critical Care Medicine, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
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      In recent years, physiologic insights into the cerebrovascular pathophysiology of hypoxic-ischemic brain injury (HIBI) have been gleaned from studies examining invasive neuromonitoring in patients post-cardiac arrest.
      • Sekhon M.S.
      • Gooderham P.
      • Menon D.K.
      • et al.
      The burden of brain hypoxia and optimal mean arterial pressure in patients with hypoxic ischemic brain injury after cardiac arrest.
      • Sekhon M.S.
      • Griesdale D.E.
      • Ainslie P.N.
      • et al.
      Intracranial pressure and compliance in hypoxic ischemic brain injury patients after cardiac arrest.
      • Sekhon M.S.
      • Ainslie P.N.
      • Menon D.K.
      • et al.
      Brain hypoxia secondary to diffusion limitation in hypoxic ischemic brain injury post-cardiac arrest.
      In the latest issue of Resuscitation, Balu and colleagues conducted a single center retrospective cohort study of invasive neuromonitoring in HIBI patients which demonstrated associations between intracranial hypertension as well as dysfunctional cerebral autoregulation, measured using pressure reactivity index (PRx), and adverse clinical outcome.
      • Balu R.
      • Rajagopalan S.
      • Baghshomali S.
      • et al.
      Cerebrovascular pressure reactivity and intracranial pressure are associated with neurologic outcome after hypoxic-ischemic brain injury.
      We congratulate the authors on providing a valuable contribution to this rapidly evolving field. Notwithstanding, there are key considerations which must be taken into account when interpreting the utility of PRx as a measure of autoregulation in the cerebrovascular pathophysiology of acute brain injuries, namely HIBI.
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