Doppler sonography of cerebral blood flow for early prognostication after out-of-hospital cardiac arrest: DOTAC study

Abstract

Aim: To assess the neurological prognosis of comatose survivors of cardiac arrest by early transcranial Doppler sonography (TCD).

Methods: This was a prospective study performed between May 2016 and October 2017 in a medical intensive care unit (ICU) and a cardiac ICU of a university teaching hospital. All patients older than 18 years who were successfully resuscitated from an out-of-hospital cardiac arrest (OHCA) with persistent coma after the return of spontaneous circulation (ROSC) were eligible. We excluded patients for whom OHCA was associated with traumatic brain injury, no possibility of TCD measurements, or who were dead before establishing the neurological prognosis. We measured the pulsatility index (PI) and diastolic flow velocity (DFV) of the right and left middle cerebral arteries within 12 h after ICU admission. The lowest DFV and highest PI values were used for the statistical analysis. The neurological outcome at hospital discharge was evaluated by the cerebral performance category.

Results: Forty-two patients were included in the final analysis: 15 had good and 27 poor neurological outcomes. The PI was higher in the poor outcome (1.49 vs. 1.12, p = 0.01) than good outcome group and the DFV was lower in the poor outcome group (17.3 cm s^-1vs. 26.0 cm s^-1; p = 0.01).

Conclusion: Data provided by early TCD after ROSC are associated with neurological outcome. The use of TCD could help guide interventions to improve cerebral perfusion after ROSC in patients resuscitated from OHCA.

Keywords: Cerebrovascular circulation; Out-of-hospital cardiac arrest; Prognosis; Transcranial Doppler sonography.