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  • Skrifvars, Markus B.; Aneman, Anders; Ameloot, Koen (2020)
    Purpose of review To discuss recent findings relevant to optimizing blood pressure targets in adult, postcardiac arrest (PCA) patients and whether to tailor these based on specific patient, cardiac arrest or treatment characteristics. Recent findings Observational data suggest that mean arterial pressure (MAP) below 65-75 mmHg in PCA patients is associated with worse outcome. A higher MAP could be beneficial in patients with chronic hypertension who more frequently have a right shift of the cerebral autoregulation curve. Two recent randomized pilot trials compared lower and higher MAP targets during PCA care and found no significant effect on biomarkers of neurological injury. The haemodynamic interventions in those studies did not use any cerebral perfusion endpoints beyond a static MAP targets during ICU stay. Individualized, dynamic MAP targets based on assessments of cerebral perfusion and tailored to the specifics of the patient, cardiac arrest circumstances and treatment responses may be more conducive to improved outcomes. Pilot data suggest that near infrared spectroscopy monitoring may be used to determine the cerebral autoregulatory capacity and an optimal MAP, but this approach is yet to be tested in clinical trials. Current evidence suggests targeting a MAP of at least 65-75 mmHg in PCA patients. Future studies should focus on whether certain patient groups could benefit from higher and dynamic MAP targets.
  • Holmström, Ester; Efendijev, Ilmar; Raj, Rahul; Pekkarinen, Pirkka T.; Litonius, Erik; Skrifvars, Markus B. (2021)
    BackgroundCardiac arrest (CA) is a leading cause of death worldwide. As population ages, the need for research focusing on CA in elderly increases. This study investigated treatment intensity, 12-month neurological outcome, mortality and healthcare-associated costs for patients aged over 75 years treated for CA in an intensive care unit (ICU) of a tertiary hospital.MethodsThis single-centre retrospective study included adult CA patients treated in a Finnish tertiary hospital's ICU between 2005 and 2013. We stratified the study population into two age groups: 75 years. We compared interventions defined by the median daily therapeutic scoring system (TISS-76) between the age groups to find differences in treatment intensity. We calculated cost-effectiveness by dividing the total one-year healthcare-associated costs of all patients by the number of survivors with a favourable neurological outcome. Favourable outcome was defined as a cerebral performance category (CPC) of 1-2 at 12 months after cardiac arrest. Logistic regression analysis was used to identify independent associations between age group, mortality and neurological outcome.ResultsThis study included a total of 1,285 patients, of which 212 (16%) were >= 75 years of age. Treatment intensity was lower for the elderly compared to the younger group, with median TISS scores of 116 and 147, respectively (p
  • Skrifvars, Markus B.; Hästbacka, Johanna (2018)
  • COMACARE Study Grp; Jakkula, Pekka; Reinikainen, Matti; Hästbacka, Johanna; Loisa, Pekka; Tiainen, Marjaana; Pettilä, Ville; Toppila, Jussi; Lähde, Marika; Bäcklund, Minna; Okkonen, Marjatta; Bendel, Stepani; Birkelund, Thomas; Pulkkinen, Anni; Heinonen, Jonna; Tikka, Tuukka; Skrifvars, Markus B. (2018)
    PurposeWe assessed the effects of targeting low-normal or high-normal arterial carbon dioxide tension (PaCO2) and normoxia or moderate hyperoxia after out-of-hospital cardiac arrest (OHCA) on markers of cerebral and cardiac injury.MethodsUsing a 2(3) factorial design, we randomly assigned 123 patients resuscitated from OHCA to low-normal (4.5-4.7kPa) or high-normal (5.8-6.0kPa) PaCO2 and to normoxia (arterial oxygen tension [PaO2] 10-15kPa) or moderate hyperoxia (PaO2 20-25kPa) and to low-normal or high-normal mean arterial pressure during the first 36h in the intensive care unit. Here we report the results of the low-normal vs. high-normal PaCO2 and normoxia vs. moderate hyperoxia comparisons. The primary endpoint was the serum concentration of neuron-specific enolase (NSE) 48h after cardiac arrest. Secondary endpoints included S100B protein and cardiac troponin concentrations, continuous electroencephalography (EEG) and near-infrared spectroscopy (NIRS) results and neurologic outcome at 6months.ResultsIn total 120 patients were included in the analyses. There was a clear separation in PaCO2 (p