Transfer function analysis of dynamic cerebral autoregulation: A CARNet white paper 2022 update

Area of Science:

• Neuroscience
• Cerebrovascular Physiology
• Medical Technology

Background:

• Cerebral autoregulation (CA) maintains stable cerebral blood flow (CBF) despite fluctuating mean arterial pressure (MAP).
• Dynamic CA (dCA) assessment, commonly via transfer function analysis (TFA), requires standardized methods.
• A previous 2016 white paper provided initial TFA guidelines for cerebral autoregulation research.

Purpose of the Study:

• To present an updated, evidence-based white paper on dynamic cerebral autoregulation assessment.
• To refine and expand guidelines for TFA and introduce recommendations for emerging dCA research areas.
• To enhance the reliability, reproducibility, and collaborative potential of dCA studies.

Main Methods:

• Review and synthesis of recent evidence and advancements in dynamic cerebral autoregulation research.
• Development of revised data acquisition, analysis, and reporting guidelines for TFA.
• Inclusion of new guidelines addressing MAP variability, alternative CBF estimation, novel dCA metrics, and clinical trial integration.

Main Results:

• A second edition of the white paper with more robust, evidence-based recommendations for dCA assessment.
• Expanded guidelines covering optimized MAP variability, alternative CBF methods, and new dCA metrics.
• Recommendations for incorporating dCA quantification into clinical trials.

Conclusions:

• Implementation of these refined guidelines is crucial for improving the quality of dCA research.
• Standardized dCA assessment facilitates inter-institutional collaboration and result comparability.
• These updated recommendations support the advancement of understanding and applying cerebral autoregulation in clinical settings.