Skip to main content

One-size-fits-all or patient-tailored hemodynamic targets in post-cardiac arrest patients: an observational near-infrared spectroscopy study on cerebral autoregulation

Introduction

A subgroup of post-CA patients with disturbed cerebral autoregulation might benefit from higher mean arterial pressures (MAPs). We aimed to (1) investigate whether patients with disturbed autoregulation have a worse prognosis, (2) phenotype these patients, (3) define an individual optimal MAP and (4) investigate whether time under this individual optimal MAP is associated with outcome.

Methods

A prospective observational study in 51 post-CA patients monitored with near-infrared spectroscopy.

Results

(1) In multivariate analysis, patients with preserved autoregulation (33.65%) had a significant higher 180-day survival rate (OR = 4.62, 95% CI (1.06; 20.06), P = 0.04). (2) Phenotypically, a higher proportion of patients with disturbed autoregulation had pre-CA hypertension (31 ± 47 vs. 65 ± 49%, P = 0.02) suggesting that right shifting of autoregulation is caused by chronic adaptation of cerebral blood flow to higher blood pressures. Based on an index of autoregulation (COX), the average COX-predicted optimal MAP was 85 mmHg in patients with preserved and 100 mmHg in patients with disturbed autoregulation. (3) An individual optimal MAP could be determined in 33/51 patients. (4) The time under the individual optimal MAP was negatively associated with survival (OR = 0.97, 95% CI (0.96; 0.99), P = 0.02). The time under previously proposed fixed targets (65, 70, 75, 80 mmHg) was not associated with a differential survival rate.

Conclusion

Cerebral autoregulation was shown to be disturbed in 35% of post-CA patients of which a majority had pre-CA hypertension. Disturbed cerebral autoregulation within the first 24 hours after CA is associated with a worse outcome. In contrast to uniform MAP goals, the time spent under a patient-tailored optimal MAP, based on an index of autoregulation, was negatively associated with survival.

Author information

Affiliations

Authors

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Genbrugge, C., Ameloot, K., Meex, I. et al. One-size-fits-all or patient-tailored hemodynamic targets in post-cardiac arrest patients: an observational near-infrared spectroscopy study on cerebral autoregulation. Crit Care 19, P432 (2015). https://doi.org/10.1186/cc14512

Download citation

Keywords

  • Cerebral Blood Flow
  • Prospective Observational Study
  • Differential Survival
  • Cerebral Autoregulation
  • Chronic Adaptation