Association of deranged cerebrovascular reactivity with brain injury following cardiac arrest : a post-hoc analysis of the COMACARE trial

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Laurikkala , J , Aneman , A , Peng , A , Reinikainen , M , Pham , P , Jakkula , P , Hästbacka , J , Wilkman , E , Loisa , P , Toppila , J , Birkelund , T , Blennow , K , Zetterberg , H & Skrifvars , M B 2021 , ' Association of deranged cerebrovascular reactivity with brain injury following cardiac arrest : a post-hoc analysis of the COMACARE trial ' , Critical Care , vol. 25 , no. 1 , 350 . https://doi.org/10.1186/s13054-021-03764-6

Title: Association of deranged cerebrovascular reactivity with brain injury following cardiac arrest : a post-hoc analysis of the COMACARE trial
Author: Laurikkala, Johanna; Aneman, Anders; Peng, Alexander; Reinikainen, Matti; Pham, Paul; Jakkula, Pekka; Hästbacka, Johanna; Wilkman, Erika; Loisa, Pekka; Toppila, Jussi; Birkelund, Thomas; Blennow, Kaj; Zetterberg, Henrik; Skrifvars, Markus B.
Other contributor: University of Helsinki, Anestesiologian yksikkö
University of Helsinki, HUS Perioperative, Intensive Care and Pain Medicine
University of Helsinki, Clinicum
University of Helsinki, Department of Diagnostics and Therapeutics
University of Helsinki, HYKS erva
University of Helsinki, Department of Neurosciences
University of Helsinki, HUS Emergency Medicine and Services











Date: 2021-09-28
Language: eng
Number of pages: 12
Belongs to series: Critical Care
ISSN: 1364-8535
DOI: https://doi.org/10.1186/s13054-021-03764-6
URI: http://hdl.handle.net/10138/336546
Abstract: Background: Impaired cerebrovascular reactivity (CVR) is one feature of post cardiac arrest encephalopathy. We studied the incidence and features of CVR by near infrared spectroscopy (NIRS) and associations with outcome and biomarkers of brain injury. Methods: A post-hoc analysis of 120 comatose OHCA patients continuously monitored with NIRS and randomised to low- or high-normal oxygen, carbon dioxide and mean arterial blood pressure (MAP) targets for 48 h. The tissue oximetry index-(TOx) generated by the moving correlation coefficient between cerebral tissue oxygenation measured by NIRS and MAP was used as a dynamic index of CVR with-TOx > 0 indicating impaired reactivity and TOx > 0.3 used to delineate the lower and upper MAP bounds for disrupted CVR. TOx was analysed in the 0-12, 12-24, 24-48 h timeperiods and integrated over 0-48 h. The primary outcome was the association between TOx and six-month functional outcome dichotomised by the cerebral performance category (CPC1-2 good vs. 3-5 poor). Secondary outcomes included associations with MAP bounds for CVR and biomarkers of brain injury. Results: In 108 patients with sufficient data to calculate TOx, 76 patients (70%) had impaired CVR and among these, chronic hypertension was more common (58% vs. 31%, p = 0.002). Integrated TOx for 0-48 h was higher in patients with poor outcome than in patients with good outcome (0.89 95% CI [- 1.17 to 2.94] vs. - 2.71 95% CI [- 4.16 to - 1.26], p = 0.05). Patients with poor outcomes had a decreased upper MAP bound of CVR over time (p = 0.001), including the high-normal oxygen (p = 0.002), carbon dioxide (p = 0.012) and MAP (p = 0.001) groups. The MAP range of maintained CVR was narrower in all time intervals and intervention groups (p < 0.05). NfL concentrations were higher in patients with impaired CVR compared to those with intact CVR (43 IQR [15-650] vs 20 IQR [13-199] pg/ml, p = 0.042). Conclusion: Impaired CVR over 48 h was more common in patients with chronic hypertension and associated with poor outcome. Decreased upper MAP bound and a narrower MAP range for maintained CVR were associated with poor outcome and more severe brain injury assessed with NfL.
Subject: Cerebrovascular reactivity
Out-of-hospital cardiac arrest
Hypoxic-ischaemic brain injury
NEAR-INFRARED SPECTROSCOPY
CEREBRAL-BLOOD-FLOW
MEAN ARTERIAL-PRESSURE
INTENSIVE-CARE-UNIT
AUTOREGULATION
OXYGEN
TIME
RESUSCITATION
TARGETS
3126 Surgery, anesthesiology, intensive care, radiology
3121 General medicine, internal medicine and other clinical medicine
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