Aim

Evaluate cerebrovascular autoregulation (CAR) using near-infrared spectroscopy (NIRS) after pediatric cardiac arrest and determine if deviations from CAR-derived optimal mean arterial pressure (MAP_opt) are associated with outcomes.

Methods

CAR was quantified by a moving, linear correlation between time-synchronized mean arterial pressure (MAP) and regional cerebral oxygenation, called cerebral oximetry index (COx). MAP_opt was calculated using a multi-window weighted algorithm. We calculated burden (magnitude and duration) of MAP less than 5 mmHg below MAP_opt (MAPopt - 5), as the area between MAP and MAPopt - 5 curves using numerical integration and normalized as percentage of monitoring duration. Unfavorable outcome was defined as death or pediatric cerebral performance category (PCPC) at hospital discharge ≥3 with ≥1 change from baseline. Univariate logistic regression tested association between burden of MAP less than MAPopt - 5 and outcome.

Results

Thirty-four children (median age 2.9 [IQR 1.5,13.4] years) were evaluated. Median COx in the first 24 h post-cardiac arrest was 0.06 [0,0.20]; patients spent 27% [19,43] of monitored time with COx ≥ 0.3. Patients with an unfavorable outcome (n = 24) had a greater difference between MAP and MAPopt - 5 (13 [11,19] vs. 9 [8,10] mmHg, p = 0.01) and spent more time with MAP below MAPopt - 5 (38% [26,61] vs. 24% [14,28], p = 0.03). Patients with unfavorable outcome had a higher burden of MAP less than MAPopt - 5 than patients with favorable outcome in the first 24 h post-arrest (187 [107,316] vs. 62 [43,102] mmHg × Min/Hr; OR 4.93 [95% CI 1.16–51.78]).

Conclusions

Greater burden of MAP below NIRS-derived MAPopt - 5 during the first 24 h after cardiac arrest was associated with unfavorable outcomes.

中文翻译：

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与 NIRS 衍生的最佳血压的偏差与儿科心脏骤停后更差的结果相关

目标

在小儿心脏骤停后使用近红外光谱 (NIRS) 评估脑血管自动调节 (CAR)，并确定与 CAR 衍生的最佳平均动脉压 (MAP _opt ) 的偏差是否与结果相关。

方法

CAR通过时间同步平均动脉压（MAP）和局部脑氧合（称为脑血氧指数（COx））之间的移动线性相关性来量化。MAP _opt是使用多窗口加权算法计算的。我们计算了低于 MAP _opt (MAPopt - 5) 的 MAP 的负担（幅度和持续时间），作为 MAP 和 MAPopt - 5 曲线之间的面积，使用数值积分并归一化为监测持续时间的百分比。不良结局定义为出院时死亡或小儿脑功能分类（PCPC）≥3，与基线相比变化≥1。单变量逻辑回归测试了小于 MAPopt-5 的 MAP 负担与结果之间的关联。

结果

对 34 名儿童（中位年龄 2.9 [IQR 1.5,13.4] 岁）进行了评估。心脏骤停后最初 24 小时的 COx 中位数为 0.06 [0,0.20]；患者在 COx ≥ 0.3 的情况下花费了 27% [19,43] 的监测时间。结果不佳（ n = 24）的患者 在 MAP 和 MAPopt 之间有更大的差异 - 5（13 [11,19] 对 9 [8,10] mmHg，p  = 0.01）并且在 MAPopt 以下花费更多时间 - 5（38% [26,61] 对 24% [14,28]，p  = 0.03）。预后不良的患者的 MAP 负担低于 MAPopt - 5 的患者在停搏后最初 24 小时内高于预后良好的患者（187 [107,316] vs. 62 [43,102] mmHg × Min/Hr；OR 4.93 [95% CI 1.16–51.78]）。

结论

在心脏骤停后的前 24 小时内，低于 NIRS 衍生的 MAPopt-5 的 MAP 负担更大与不利的结果相关。