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. 2017 Dec;159(12):2245-2273.
doi: 10.1007/s00701-017-3338-2. Epub 2017 Oct 7.

A systematic review of cerebral microdialysis and outcomes in TBI: relationships to patient functional outcome, neurophysiologic measures, and tissue outcome

Frederick A Zeiler  1   2   3 , Eric Peter Thelin  4   5 , Adel Helmy  4 , Marek Czosnyka  4   6 , Peter J A Hutchinson  4 , David K Menon  7   8   9   10
Affiliations

A systematic review of cerebral microdialysis and outcomes in TBI: relationships to patient functional outcome, neurophysiologic measures, and tissue outcome

Frederick A Zeiler et al. Acta Neurochir (Wien). 2017 Dec.

Abstract

Objective: To perform a systematic review on commonly measured cerebral microdialysis (CMD) analytes and their association to: (A) patient functional outcome, (B) neurophysiologic measures, and (C) tissue outcome; after moderate/severe TBI. The aim was to provide a foundation for next-generation CMD studies and build on existing pragmatic expert guidelines for CMD.

Methods: We searched MEDLINE, BIOSIS, EMBASE, Global Health, Scopus, Cochrane Library (inception to October 2016). Strength of evidence was adjudicated using GRADE.

Results: (A) Functional Outcome: 55 articles were included, assessing outcome as mortality or Glasgow Outcome Scale (GOS) at 3-6 months post-injury. Overall, there is GRADE C evidence to support an association between CMD glucose, glutamate, glycerol, lactate, and LPR to patient outcome at 3-6 months. (B) Neurophysiologic Measures: 59 articles were included. Overall, there currently exists GRADE C level of evidence supporting an association between elevated CMD measured mean LPR, glutamate and glycerol with elevated ICP and/or decreased CPP. In addition, there currently exists GRADE C evidence to support an association between elevated mean lactate:pyruvate ratio (LPR) and low PbtO2. Remaining CMD measures and physiologic outcomes displayed GRADE D or no evidence to support a relationship. (C) Tissue Outcome: four studies were included. Given the conflicting literature, the only conclusion that can be drawn is acute/subacute phase elevation of CMD measured LPR is associated with frontal lobe atrophy at 6 months.

Conclusions: This systematic review replicates previously documented relationships between CMD and various outcome, which have driven clinical application of the technique. Evidence assessments do not address the application of CMD for exploring pathophysiology or titrating therapy in individual patients, and do not account for the modulatory effect of therapy on outcome, triggered at different CMD thresholds in individual centers. Our findings support clinical application of CMD and refinement of existing guidelines.

Keywords: Cerebral microdialysis; Functional outcome; Patient outcome; Systematic review.

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Conflict of interest statement

FAZ has received salary support for dedicated research time, during which this project was partially completed. Such salary support came from: the Cambridge Commonwealth Trust Scholarship, the Royal College of Surgeons of Canada – Harry S. Morton Traveling Fellowship in Surgery, the University of Manitoba Clinician Investigator Program, R. Samuel McLaughlin Research and Education Award, the Manitoba Medical Service Foundation, and the University of Manitoba - Faculty of Medicine Dean’s Fellowship Fund.

EPT has received funding support from Swedish Society of Medicine (Grant no. SLS-587221).

MC has financial interest in a part of licensing fee for ICM+ software (Cambridge Enterprise Ltd., UK). Unpaid co-Director of Technicam Ltd.- producer of Cranial Access Device used for CMD insertion.

PJAH is the director of Technicam manufacturer of the Technicam Cranial Access Device.

DKM has consultancy agreements and/or research collaborations with GlaxoSmithKline Ltd.; Ornim Medical; Shire Medical Ltd.; Calico Inc.; Pfizer Ltd.; Pressura Ltd.; Glide Pharma Ltd.; and NeuroTraumaSciences LLC.

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