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Association between time-dependent changes in cerebrovascular autoregulation after cardiac arrest and outcomes: A
Jotaro Tachino1, Yuta Nonomiya2, Satsuki Taniuchi2
1Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Osaka, Japan.
Insights
Impaired cerebrovascular autoregulation (CVAR) is linked to worse outcomes in cardiac arrest (CA) survivors. Minimizing time without CVAR may improve neurological recovery and survival after hypoxic-ischemic brain injury.
Area of Science:
- Neurology
- Critical Care Medicine
- Neuroscience
Background:
- Hypoxic-ischemic brain injury (HIBI) following cardiac arrest (CA) is a major cause of mortality and long-term disability.
- Cerebrovascular autoregulation (CVAR) plays a critical role in maintaining stable cerebral blood flow, particularly under stress.
- Understanding the relationship between CVAR and patient outcomes is crucial for optimizing post-CA care.
Purpose of the Study:
- To investigate the association between cerebrovascular autoregulation (CVAR) and neurological outcomes in patients who experienced return of spontaneous circulation after cardiac arrest.
- To evaluate the impact of non-CVAR time on survival and neurological recovery.
- To assess the influence of target temperature management (TTM) in conjunction with CVAR on patient outcomes.
Main Methods:
- Prospective observational single-center cohort study of 100 post-CA patients.
- Continuous monitoring for 96 hours to assess CVAR using moving Pearson correlation between mean arterial pressure and cerebral regional oxygen saturation.
- Cox proportional hazard model used to evaluate the association between non-CVAR time percent and outcomes, with adjustment for age and TTM.
Main Results:
- CVAR was present in all patients with good neurological outcomes (CPC 1-2) and 88% of those with poor outcomes (CPC 3-5).
- Increased percentage of time without CVAR was significantly associated with decreased survival probability.
- Target temperature management (TTM) was associated with a lower probability of poor neurological outcome at 6 months, particularly when non-CVAR time was between 18%-37%.
Conclusions:
- Prolonged periods of impaired cerebrovascular autoregulation (non-CVAR time) are significantly associated with increased mortality in patients with hypoxic-ischemic brain injury post-cardiac arrest.
- Maintaining intact CVAR is critical for favorable neurological outcomes and survival.
- Target temperature management may be more effective in improving outcomes when combined with strategies to preserve CVAR.
Abstract:
This prospective observational single-center cohort study aimed to determine an association between cerebrovascular autoregulation (CVAR) and outcomes in hypoxic-ischemic brain injury post-cardiac arrest (CA), and assessed 100 consecutive post-CA patients in Japan between June 2017 and May 2020 who experienced a return of spontaneous circulation. Continuous monitoring was performed for 96 h to determine CVAR presence. A moving Pearson correlation coefficient was calculated from the mean arterial pressure and cerebral regional oxygen saturation. The association between CVAR and outcomes was evaluated using the Cox proportional hazard model; non-CVAR time percent was the time-dependent, age-adjusted covariate. The non-linear effect of target temperature management (TTM) was assessed using a restricted cubic spline. Of the 100 participants, CVAR was detected using the cerebral performance category (CPC) in all patients with a good neurological outcome (CPC 1-2) and in 65 patients (88%) with a poor outcome (CPC 3-5). Survival probability decreased significantly with increasing non-CVAR time percent. The TTM versus the non-TTM group had a significantly lower probability of a poor neurological outcome at 6 months with a non-CVAR time of 18%-37% (p < 0.05). Longer non-CVAR time may be associated with significantly increased mortality in hypoxic-ischemic brain injury post-CA.
