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. 2023 Oct 4:14:1222401.
doi: 10.3389/fneur.2023.1222401. eCollection 2023.

Transcranial Doppler during the first week after cardiac arrest and association with 6-month outcomes

Antje Reichenbach  1 , Lars Alteheld  2 , Julia Henriksen  2 , Espen Rostrup Nakstad  3   4 , Geir Øystein Andersen  5 , Kjetil Sunde  6   7 , Jūratė Šaltytė Benth  8   9 , Christofer Lundqvist  1   8   9
Affiliations

Transcranial Doppler during the first week after cardiac arrest and association with 6-month outcomes

Antje Reichenbach et al. Front Neurol. .

Abstract

Background: Early prediction of outcomes in comatose patients after out-of-hospital cardiac arrest is challenging. Prognostication tools include clinical examination, biomarkers, and neuroradiological and neurophysiological tests. We studied the association between transcranial Doppler (TCD) and the outcome.

Methods: This was a pre-defined sub-study of the prospective observational Norwegian Cardiorespiratory Arrest Study. Patients underwent standardized post-resuscitation care, including target temperature management (TTM) to 33°C for 24 h. TCD was performed at days 1, 3, and 5-7. The primary endpoint was cerebral performance category (CPC) at 6 months, dichotomized into good (CPC 1-2) and poor (CPC 3-5) outcomes. We used linear mixed modeling time-series analysis.

Results: Of 139 TCD-examined patients, 81 (58%) had good outcomes. Peak systolic velocity in the middle cerebral artery (PSV) was low during TTM (Day 1) and elevated after rewarming (Day 3). Thereafter, it continued to rise in patients with poor, but normalized in patients with good, outcomes. At days 5-7, PSV was 1.0 m/s (95% CI 0.9; 1.0) in patients with good outcomes and 1.3 m/s (95% CI 1.1; 1.4) in patients with poor outcomes (p < 0.001).

Conclusion: Elevated PSV at days 5-7 indicated poor outcomes. Our findings suggest that serial TCD examinations during the first week after cardiorespiratory arrest may improve our understanding of serious brain injury.

Keywords: brain; brain damage; cardiac arrest (CA); heart; out of hospital arrest; 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
Bedside transcranial Doppler of the middle cerebral artery (the figure is intended to illustrate the basic principle and anatomy of transcranial ultrasound and may not show exactly the same probe as used in the study). (Figure above reproduced by kind permission from Rune Aaslid).
Figure 2
Figure 2
STROBE flowchart of patients included in the TCD sub-study. AMI, acute myocardial infarction; CCAD, chronic coronary artery disease; CA, cardiac arrest; CPC, cerebral performance category.
Figure 3
Figure 3
Relationship between day 7 TCD parameters (PSV, PI, and RI in the right (open symbols, dashed lines) and left (filled symbols, continuous lines) MCA and clinical outcome. Numbers are means and 95% confidence intervals.
Figure 4
Figure 4
Time trend in PSV and MV, results of the unadjusted linear mixed model. The linear mixed model showed a significant time dependence (p = 0.004) and a significant difference in flow pattern between outcome groups (p < 0.001), see also Table 2.
See this image and copyright information in PMC

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