A pilot study of cerebrovascular reactivity autoregulation after pediatric cardiac arrest

Jennifer Lee-Summers, Ken M. Brady, Shang En Chung, Jacky Jennings, Emmett E. Whitaker, Devon Aganga, Ronald B. Easley, Kerry Heitmiller, Jessica L. Jamrogowicz, Abby C. Larson, Jeong Hoo Lee, Lori C. Jordan, Charles W. Hogue, Christoph U. Lehmann, Melania Bembea, Elizabeth Hunt, Raymond C Koehler, Donald Harry Shaffner

Research output: Contribution to journalArticle

Abstract

Aim: Improved survival after cardiac arrest has placed greater emphasis on neurologic resuscitation. The purpose of this pilot study was to evaluate the relationship between cerebrovascular autoregulation and neurologic outcomes after pediatric cardiac arrest. Methods: Children resuscitated from cardiac arrest had autoregulation monitoring during the first 72h after return of circulation with an index derived from near-infrared spectroscopy in a pilot study. The range of mean arterial blood pressure (MAP) with optimal vasoreactivity (MAPOPT) was identified. The area under the curve (AUC) of the time spent with MAP below MAPOPT and MAP deviation below MAPOPT was calculated. Neurologic outcome measures included placement of a new tracheostomy or gastrostomy, death from a primary neurologic etiology (brain death or withdrawal of support for neurologic futility), and change in the Pediatric Cerebral Performance Category score (δPCPC). Results: Thirty-six children were monitored. Among children who did not require extracorporeal membrane oxygenation (ECMO), children who received a tracheostomy/gastrostomy had greater AUC during the second 24h after resuscitation than those who did not (P=0.04; n=19). Children without ECMO who died from a neurologic etiology had greater AUC during the first 48h than did those who lived or died from cardiovascular failure (P=0.04; n=19). AUC below MAPOPT was not associated with δPCPC when children with or without ECMO were analyzed separately. Conclusions: Deviation from the blood pressure with optimal autoregulatory vasoreactivity may predict poor neurologic outcomes after pediatric cardiac arrest. This experimental autoregulation monitoring technique may help individualize blood pressure management goals after resuscitation.

Original languageEnglish (US)
Pages (from-to)1387-1393
Number of pages7
JournalResuscitation
Volume85
Issue number10
DOIs
StatePublished - Oct 1 2014

Fingerprint

Heart Arrest
Nervous System
Homeostasis
Arterial Pressure
Pediatrics
Extracorporeal Membrane Oxygenation
Area Under Curve
Resuscitation
Gastrostomy
Tracheostomy
Medical Futility
Blood Pressure
Brain Death
Near-Infrared Spectroscopy
Outcome Assessment (Health Care)

Keywords

  • Blood pressure
  • Brain injuries
  • Cerebrovascular circulation
  • Heart arrest
  • Pediatrics

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Emergency
  • Emergency Medicine

Cite this

A pilot study of cerebrovascular reactivity autoregulation after pediatric cardiac arrest. / Lee-Summers, Jennifer; Brady, Ken M.; Chung, Shang En; Jennings, Jacky; Whitaker, Emmett E.; Aganga, Devon; Easley, Ronald B.; Heitmiller, Kerry; Jamrogowicz, Jessica L.; Larson, Abby C.; Lee, Jeong Hoo; Jordan, Lori C.; Hogue, Charles W.; Lehmann, Christoph U.; Bembea, Melania; Hunt, Elizabeth; Koehler, Raymond C; Shaffner, Donald Harry.

In: Resuscitation, Vol. 85, No. 10, 01.10.2014, p. 1387-1393.

Research output: Contribution to journalArticle

Lee-Summers, J, Brady, KM, Chung, SE, Jennings, J, Whitaker, EE, Aganga, D, Easley, RB, Heitmiller, K, Jamrogowicz, JL, Larson, AC, Lee, JH, Jordan, LC, Hogue, CW, Lehmann, CU, Bembea, M, Hunt, E, Koehler, RC & Shaffner, DH 2014, 'A pilot study of cerebrovascular reactivity autoregulation after pediatric cardiac arrest', Resuscitation, vol. 85, no. 10, pp. 1387-1393. https://doi.org/10.1016/j.resuscitation.2014.07.006
Lee-Summers, Jennifer ; Brady, Ken M. ; Chung, Shang En ; Jennings, Jacky ; Whitaker, Emmett E. ; Aganga, Devon ; Easley, Ronald B. ; Heitmiller, Kerry ; Jamrogowicz, Jessica L. ; Larson, Abby C. ; Lee, Jeong Hoo ; Jordan, Lori C. ; Hogue, Charles W. ; Lehmann, Christoph U. ; Bembea, Melania ; Hunt, Elizabeth ; Koehler, Raymond C ; Shaffner, Donald Harry. / A pilot study of cerebrovascular reactivity autoregulation after pediatric cardiac arrest. In: Resuscitation. 2014 ; Vol. 85, No. 10. pp. 1387-1393.
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abstract = "Aim: Improved survival after cardiac arrest has placed greater emphasis on neurologic resuscitation. The purpose of this pilot study was to evaluate the relationship between cerebrovascular autoregulation and neurologic outcomes after pediatric cardiac arrest. Methods: Children resuscitated from cardiac arrest had autoregulation monitoring during the first 72h after return of circulation with an index derived from near-infrared spectroscopy in a pilot study. The range of mean arterial blood pressure (MAP) with optimal vasoreactivity (MAPOPT) was identified. The area under the curve (AUC) of the time spent with MAP below MAPOPT and MAP deviation below MAPOPT was calculated. Neurologic outcome measures included placement of a new tracheostomy or gastrostomy, death from a primary neurologic etiology (brain death or withdrawal of support for neurologic futility), and change in the Pediatric Cerebral Performance Category score (δPCPC). Results: Thirty-six children were monitored. Among children who did not require extracorporeal membrane oxygenation (ECMO), children who received a tracheostomy/gastrostomy had greater AUC during the second 24h after resuscitation than those who did not (P=0.04; n=19). Children without ECMO who died from a neurologic etiology had greater AUC during the first 48h than did those who lived or died from cardiovascular failure (P=0.04; n=19). AUC below MAPOPT was not associated with δPCPC when children with or without ECMO were analyzed separately. Conclusions: Deviation from the blood pressure with optimal autoregulatory vasoreactivity may predict poor neurologic outcomes after pediatric cardiac arrest. This experimental autoregulation monitoring technique may help individualize blood pressure management goals after resuscitation.",
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AU - Lee-Summers, Jennifer

AU - Brady, Ken M.

AU - Chung, Shang En

AU - Jennings, Jacky

AU - Whitaker, Emmett E.

AU - Aganga, Devon

AU - Easley, Ronald B.

AU - Heitmiller, Kerry

AU - Jamrogowicz, Jessica L.

AU - Larson, Abby C.

AU - Lee, Jeong Hoo

AU - Jordan, Lori C.

AU - Hogue, Charles W.

AU - Lehmann, Christoph U.

AU - Bembea, Melania

AU - Hunt, Elizabeth

AU - Koehler, Raymond C

AU - Shaffner, Donald Harry

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Y1 - 2014/10/1

N2 - Aim: Improved survival after cardiac arrest has placed greater emphasis on neurologic resuscitation. The purpose of this pilot study was to evaluate the relationship between cerebrovascular autoregulation and neurologic outcomes after pediatric cardiac arrest. Methods: Children resuscitated from cardiac arrest had autoregulation monitoring during the first 72h after return of circulation with an index derived from near-infrared spectroscopy in a pilot study. The range of mean arterial blood pressure (MAP) with optimal vasoreactivity (MAPOPT) was identified. The area under the curve (AUC) of the time spent with MAP below MAPOPT and MAP deviation below MAPOPT was calculated. Neurologic outcome measures included placement of a new tracheostomy or gastrostomy, death from a primary neurologic etiology (brain death or withdrawal of support for neurologic futility), and change in the Pediatric Cerebral Performance Category score (δPCPC). Results: Thirty-six children were monitored. Among children who did not require extracorporeal membrane oxygenation (ECMO), children who received a tracheostomy/gastrostomy had greater AUC during the second 24h after resuscitation than those who did not (P=0.04; n=19). Children without ECMO who died from a neurologic etiology had greater AUC during the first 48h than did those who lived or died from cardiovascular failure (P=0.04; n=19). AUC below MAPOPT was not associated with δPCPC when children with or without ECMO were analyzed separately. Conclusions: Deviation from the blood pressure with optimal autoregulatory vasoreactivity may predict poor neurologic outcomes after pediatric cardiac arrest. This experimental autoregulation monitoring technique may help individualize blood pressure management goals after resuscitation.

AB - Aim: Improved survival after cardiac arrest has placed greater emphasis on neurologic resuscitation. The purpose of this pilot study was to evaluate the relationship between cerebrovascular autoregulation and neurologic outcomes after pediatric cardiac arrest. Methods: Children resuscitated from cardiac arrest had autoregulation monitoring during the first 72h after return of circulation with an index derived from near-infrared spectroscopy in a pilot study. The range of mean arterial blood pressure (MAP) with optimal vasoreactivity (MAPOPT) was identified. The area under the curve (AUC) of the time spent with MAP below MAPOPT and MAP deviation below MAPOPT was calculated. Neurologic outcome measures included placement of a new tracheostomy or gastrostomy, death from a primary neurologic etiology (brain death or withdrawal of support for neurologic futility), and change in the Pediatric Cerebral Performance Category score (δPCPC). Results: Thirty-six children were monitored. Among children who did not require extracorporeal membrane oxygenation (ECMO), children who received a tracheostomy/gastrostomy had greater AUC during the second 24h after resuscitation than those who did not (P=0.04; n=19). Children without ECMO who died from a neurologic etiology had greater AUC during the first 48h than did those who lived or died from cardiovascular failure (P=0.04; n=19). AUC below MAPOPT was not associated with δPCPC when children with or without ECMO were analyzed separately. Conclusions: Deviation from the blood pressure with optimal autoregulatory vasoreactivity may predict poor neurologic outcomes after pediatric cardiac arrest. This experimental autoregulation monitoring technique may help individualize blood pressure management goals after resuscitation.

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