Dataset Information

A novel approach to assess cerebral and coronary perfusion after cardiac arrest.

ABSTRACT:

Background

Several indices exist to assess cerebral perfusion after cardiac arrest (CA). We aimed to investigate a new approach allowing absolute flow and microvascular resistance measurement based on selective arterial continuous thermodilution before and after CA resuscitation in a porcine model.

Methods

In anaesthetised pigs, intravascular absolute cerebral blood flow (CBF) and absolute coronary blood flow (ABF) with corresponding microvascular resistances were measured. CA was induced using overdrive pacing with 3 (group 1, n?=?5) or 5 min (group 2, n?=?8) of no flow. After resuscitation, CBF was performed at baseline, at 15 min (T15) and at 30 min (T30). Thereafter, CBF in the contralateral cerebral artery and ABF were measured.

Results

The protocol could not be completed in three pigs from group 2 due to haemodynamic instability. In the entire cohort, CBF was significantly lower at T30 after CA (0.026?±?0.02 L/min vs 0.040?±?0.03 at baseline; p?=?0.03) and cerebral microvascular resistances were significantly higher (3202?±?1838 Woods units vs 2014?±?1015 at baseline; p?=?0.04). ABF and resistances remained stable at baseline, as compared to T30 (0.122?±?0.05 vs. 0.143?±?0.06 L/min; p?=?0.15 and 563?±?203 vs. 478?±?181 Woods units; p?=?0.36, respectively). At T30, no significant differences in cerebral flow dynamics were observed between groups.

Conclusions

ABF and CBF measurement after CA resuscitation is feasible with thermodilution technique, allowing accurate monitoring and measurements. This novel approach allows simultaneous measurements of flow and microvascular resistances. This animal model simplifies cerebral perfusion measurements and allows to test new therapies to reduce cerebral injury post cardiac arrest.

SUBMITTER: Adjedj J

PROVIDER: S-EPMC6182017 | biostudies-literature | 2018 Oct

REPOSITORIES: biostudies-literature

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Publications

A novel approach to assess cerebral and coronary perfusion after cardiac arrest.

Adjedj Julien J Picard Fabien F Vanhaverbeke Maarten M De Bruyne Bernard B Cariou Alain A Wu Ming M Janssens Stefan S Varenne Olivier O

Intensive care medicine experimental 20181012 1

<h4>Background</h4>Several indices exist to assess cerebral perfusion after cardiac arrest (CA). We aimed to investigate a new approach allowing absolute flow and microvascular resistance measurement based on selective arterial continuous thermodilution before and after CA resuscitation in a porcine model.<h4>Methods</h4>In anaesthetised pigs, intravascular absolute cerebral blood flow (CBF) and absolute coronary blood flow (ABF) with corresponding microvascular resistances were measured. CA was ...[more]

PMID: 30311018

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Project description:BackgroundThis study aimed to evaluate whether the use of mild hypothermic circulatory arrest (HCA) with selective cerebral perfusion (SCP) in open arch procedure provides comparable perioperative results to moderate HCA for patients with dissected or degenerative arch pathologies.MethodsBetween January 2017 and September 2020, a total of 88 consecutive patients (mean age 47±11 years, 71 males) underwent open arch repair under a single surgeon at our institution with mild or moderate systemic hypothermia assisted by unilateral or bilateral SCP. Patients were divided into groups according to the nasopharyngeal temperature at the beginning of HCA: a moderate HCA group (n=47, 53.4%) and a mild HCA group (n=41, 46.6%). The postoperative mortality, morbidity, and visceral organ functions between these groups were analyzed retrospectively.ResultsCompared to the moderate HCA group, the mild HCA group had a significantly higher core temperature (nasopharynx: 24.4±0.8 vs. 28.5±2, P<0.001; bladder 25.9±0.9 vs. 30±1.2, P<0.001), and the incidence of major adverse events (MAE) in this group was markedly lower (21.3% vs. 4.9%, P=0.031). No differences were identified between the two groups refer to in-hospital mortality, permanent neurological deficit (PND), temporary neurological deficit (TND), and paraplegia (8.5% vs. 2.4%, P=0.366; 8.5% vs. 0, P=0.120; 6.4% vs. 7.3%, P=1.0; 4.3% vs. 2.4%, P=1.0, respectively). In the moderate HCA group, 6 patients (12.8%) developed acute renal failure needing replacement therapy, which did not occur in the mild HCA group (P=0.028). The duration of ventilator support and intensive care unit stay was shorter in the mild HCA group, as well as a decreased volume of drainage during the first 24 h and reduced platelet transfusion.ConclusionsThe preliminary results of the mild HCA group with SCP applied in open arch repair, mainly in total arch replacement (TAR) and stented elephant trunk (SET) implantation for aortic dissection, were satisfactory. Furthermore, comparable inferior outcomes were obtained with mild HCA compared with that of the conventional moderate HCA strategy. These encouraging surgical and postoperative results favor this more aggressive hypothermia strategy in open arch repair.

Dataset Information

A novel approach to assess cerebral and coronary perfusion after cardiac arrest.

Background

Methods

Results

Conclusions

Publications

A novel approach to assess cerebral and coronary perfusion after cardiac arrest.

Similar Datasets

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