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Review
. 2017 Oct 24;21(1):259.
doi: 10.1186/s13054-017-1832-9.

Individualized perfusion targets in hypoxic ischemic brain injury after cardiac arrest

Mypinder S Sekhon  1   2 , Donald E Griesdale  3   4   5
Affiliations
Review

Individualized perfusion targets in hypoxic ischemic brain injury after cardiac arrest

Mypinder S Sekhon et al. Crit Care. .

Abstract

Secondary injury is a major determinant of outcome in hypoxic ischemic brain injury (HIBI) after cardiac arrest and may be mitigated by optimizing cerebral oxygen delivery (CDO2). CDO2 is determined by cerebral blood flow (CBF), which is dependent upon mean arterial pressure (MAP). In health, CBF remains constant over the MAP range through cerebral autoregulation. In HIBI, the zone of intact cerebral autoregulation is narrowed and varies for each patient. Maintaining MAP within the intact autoregulation zone may mitigate ischemia, hyperemia and secondary injury. The optimal MAP in individual patients can be determined using real time autoregulation monitoring techniques.

Keywords: Cardiac arrest; Cerebral autoregulation; Cerebral oxygen delivery; Hypoxemic ischemic brain injury; Mean arterial pressure; Secondary injury.

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Conflict of interest statement

Ethics approval and consent to participate

Approval was obtained from the University of British Columbia clinical research ethics board (H15-01606).

Consent for publication

Not applicable.

Competing interests

None to report.

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Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Autoregulation-based identification of optimal mean arterial pressure after hypoxic ischemic brain injury. a A best fit U-shaped curve with the nadir of the curve representing the optimal mean arterial pressure (MAP OPT). The COx is plotted along the y-axis and mean arterial pressure in 5-mmHg bins on the x-axis, denoted as ABP. b The amount of time during the monitoring period spent within each 5-mmHg bin of mean arterial pressure. The total duration of time is denoted as a percentage on the y-axis with each 5-mmHg mean arterial pressure bin on the x-axis. This figure is original for this manuscript
See this image and copyright information in PMC

References

    1. Sekhon MS, Ainslie PN, Griesdale DE. Clinical pathophysiology of hypoxic ischemic brain injury after cardiac arrest: a “two-hit” model. Crit Care. 2017;21:90. doi: 10.1186/s13054-017-1670-9. - DOI - PMC - PubMed
    1. Nielsen N, Wetterslev J, Cronberg T, Erlinge D, Gasche Y, Hassager C, et al. Targeted temperature management at 33 °C versus 36 °C after cardiac arrest. N Engl J Med. 2013;369:2197–206. doi: 10.1056/NEJMoa1310519. - DOI - PubMed
    1. Nolan JP, Neumar RW, Adrie C, Aibiki M, Berg RA, Böttiger BW, et al. Post-cardiac arrest syndrome: epidemiology, pathophysiology, treatment, and prognostication. A Scientific Statement from the International Liaison Committee on Resuscitation; the American Heart Association Emergency Cardiovascular Care Committee; the Coun. Resuscitation. 2008;79:350–79. doi: 10.1016/j.resuscitation.2008.09.017. - DOI - PubMed
    1. Peberdy MA, Callaway CW, Neumar RW, Geocadin RG, Zimmerman JL, Donnino M, et al. Part 9: Post-cardiac arrest care: 2010 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation. 2010;122:S768–86. doi: 10.1161/CIRCULATIONAHA.110.971002. - DOI - PubMed
    1. Bhate TD, McDonald B, Sekhon MS, Griesdale DEG. Association between blood pressure and outcomes in patients after cardiac arrest: a systematic review. Resuscitation. 2015;97:1–6. doi: 10.1016/j.resuscitation.2015.08.023. - DOI - PubMed