Cerebral blood flow and cerebrovascular autoregulation in a swine model of pediatric cardiac arrest and hypothermia

Jennifer K. Lee, Ken M. Brady, Jennifer O. Mytar, Kathleen K. Kibler, Erin L. Carter, Karen G. Hirsch, Charles W. Hogue, Ronald B. Easley, Lori C. Jordan, Peter Smielewski, Marek Czosnyka, Donald H. Shaffner, Raymond C. Koehler

Research output: Contribution to journalArticle

Abstract

Objective: Knowledge remains limited regarding cerebral blood flow autoregulation after cardiac arrest and during postresuscitation hypothermia. We determined the relationship of cerebral blood flow to cerebral perfusion pressure in a swine model of pediatric hypoxic-asphyxic cardiac arrest during normothermia and hypothermia and tested novel measures of autoregulation derived from near-infrared spectroscopy. Design: Prospective, balanced animal study. Setting: Basic physiology laboratory at an academic institution. SUBJECTS:: Eighty-four neonatal swine. Interventions: Piglets underwent hypoxic-asphyxic cardiac arrest or sham surgery and recovered for 2 hrs with normothermia followed by 4 hrs of either moderate hypothermia or normothermia. In half of the groups, blood pressure was slowly decreased through inflation of a balloon catheter in the inferior vena cava to identify the lower limit of cerebral autoregulation at 6 hrs postresuscitation. In the remaining groups, blood pressure was gradually increased by inflation of a balloon catheter in the aorta to determine the autoregulatory response to hypertension. Measures of autoregulation obtained from standard laser-Doppler flowmetry and indices derived from near-infrared spectroscopy were compared. Measurements and Main Results: Laser-Doppler flux was lower in postarrest animals compared to sham-operated controls during the 2-hr normothermic period after resuscitation. During the subsequent 4-hr recovery, hypothermia decreased laser-Doppler flux in both the sham surgery and postarrest groups. Autoregulation was intact during hypertension in all groups. With arterial hypotension, postarrest, hypothermic piglets had a significant decrease in the perfusion pressure lower limit of autoregulation compared to postarrest, normothermic piglets. The near-infrared spectroscopy-derived measures of autoregulation accurately detected loss of autoregulation during hypotension. Conclusions: In a pediatric model of cardiac arrest and resuscitation, delayed induction of hypothermia decreased cerebral perfusion and decreased the lower limit of autoregulation. Metrics derived from noninvasive near-infrared spectroscopy accurately identified the lower limit of autoregulation during normothermia and hypothermia in piglets resuscitated from arrest.

Original languageEnglish (US)
Pages (from-to)2337-2345
Number of pages9
JournalCritical care medicine
Volume39
Issue number10
DOIs
StatePublished - Oct 2011

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Keywords

  • blood pressure
  • cerebrovascular circulation
  • heart arrest
  • hypothermia
  • ischemia
  • pediatrics

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

Cite this

Lee, J. K., Brady, K. M., Mytar, J. O., Kibler, K. K., Carter, E. L., Hirsch, K. G., Hogue, C. W., Easley, R. B., Jordan, L. C., Smielewski, P., Czosnyka, M., Shaffner, D. H., & Koehler, R. C. (2011). Cerebral blood flow and cerebrovascular autoregulation in a swine model of pediatric cardiac arrest and hypothermia. Critical care medicine, 39(10), 2337-2345. https://doi.org/10.1097/CCM.0b013e318223b910