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. 2022 Jan 28:8:690405.
doi: 10.3389/fmed.2021.690405. eCollection 2021.

The Utility of a Point-of-Care Transcranial Doppler Ultrasound Management Algorithm on Outcomes in Pediatric Asphyxial Out-of-Hospital Cardiac Arrest - An Exploratory Investigation

Jainn-Jim Lin  1   2   3   4 , Hsuan-Chang Kuo  5   6 , Shao-Hsuan Hsia  1 , Ying-Jui Lin  5   6 , Huei-Shyong Wang  3 , Mei-Hsin Hsu  6   7 , Ming-Chou Chiang  2   4   8 , Oi-Wa Chan  1 , En-Pei Lee  1 , Kuang-Lin Lin  3
Affiliations

The Utility of a Point-of-Care Transcranial Doppler Ultrasound Management Algorithm on Outcomes in Pediatric Asphyxial Out-of-Hospital Cardiac Arrest - An Exploratory Investigation

Jainn-Jim Lin et al. Front Med (Lausanne). .

Abstract

Background: Transcranial Doppler ultrasound is a sensitive, real time tool used for monitoring cerebral blood flow; it could provide additional information for cerebral perfusion in cerebral resuscitation during post cardiac arrest care. The aim of the current study was to evaluate the utility of a point-of-care transcranial Doppler ultrasound management algorithm on outcomes in pediatric asphyxial out-of-hospital cardiac arrest.

Methods: This retrospective cohort study was conducted in two tertiary pediatric intensive care units between January 2013 and June 2018. All children between 1 month and 18 years of age with asphyxial out-of-hospital cardiac arrest and a history of at least 3 min of chest compressions, who were treated with therapeutic hypothermia and survived for 12 h or more after the return of circulation were eligible for inclusion.

Results: Twenty-one patients met the eligibility criteria for the study. Sixteen (76.2%) of the 21 children were male, and the mean age was 2.8 ± 4.1 years. Seven (33.3%) of the children had underlying disorders. The overall 1-month survival rate was 52.4%. Twelve (57.1%) of the children received point-of-care transcranial Doppler ultrasound. The 1-month survival rate was significantly higher (p = 0.03) in the point-of-care transcranial Doppler ultrasound group (9/12, 75%) than in the non-point-of-care transcranial Doppler ultrasound group (2/9, 22.2%).

Conclusions: Point-of-care transcranial Doppler ultrasound group was associated with a significantly better 1-month survival rate compared with no point-of-care transcranial Doppler ultrasound group in pediatric asphyxial out-of-hospital cardiac arrest.

Keywords: asphyxial; out-of-hospital cardiac arrest; pediatric; point-of-care; transcranial Doppler ultrasound.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Twenty-eight patients with OHCA with therapeutic hypothermia were identified. A total of 7 children were excluded, and 21 asphyxial OHCA comatose patients were enrolled, including 12 patients who received the TCD guided cerebral resuscitation protocol and 9 patients without the TCD guided cerebral resuscitation protocol. The patients with 6-month neurological outcomes included those who died during the follow-up period. The survival rate was significantly higher (p = 0.03) in the TCD guided group (9/12, 75%) compared with the non-TCD guided group (2/9, 22.2%). OHCA, out-of-hospital cardiac arrest; PCPC, pediatric cerebral performance category; TCD, Transcranial Doppler ultrasound.
Figure 2
Figure 2
The category of transcranial Doppler ultrasound findings according to spectral pattern, PI and mean flow velocities after the ROSC. The figure was modified from references 9 and 11. ICP, Intracranial pressure; PI, pulsatility index; MV, mean velocity; ROSC, return of spontaneous circulation.
Figure 3
Figure 3
TCD guided cerebral resuscitation protocol. A stepwise management algorithm shows the clinical treatment strategy according to the pattern of Doppler spectral waveform, PI and MV of middle cerebral artery on TCD examination. H, high; N, Normal; L, low; IICP, increased intracranial pressure; TCD, Transcranial Doppler ultrasound; PI, pulsatility index; MV, mean velocity; Osmo, osmolality.
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