CHU de Québec-Université Laval Research Centre, Population Health and Optimal Health Practises Research Unit (Trauma-Emergency-Critical Care Medicine), Université Laval, 1401, 18e rue, Québec City, Québec, Canada; Division of Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, Université Laval, Québec City, Québec, Canada.
Division of Neurocritical Care, Hospital of the University of Pennsylvania, 3400 Spruce St, Philadelphia, PA 19104, United States.
Clin Neurol Neurosurg. 2020 Sep;196:105970. doi: 10.1016/j.clineuro.2020.105970. Epub 2020 May 30.
To determine if non-invasive cerebral perfusion estimation provided by a new acousto-optic technology can be used as a reliable predictor of neurological outcome.
We performed a prospective, observational cohort study of consecutive comatose patients successfully resuscitated from out-of-hospital cardiac arrest. Patients were monitored using c-FLOW (Ornim Medical) from critical care unit admission up to 72 h, full awakening, or death. Primary outcome was favourable neurological outcome at hospital discharge, defined as a Cerebral Performance Category score of 1 or 2.
A total of 21 patients were enrolled, without any loss to follow-up. Mean perfusion index over the monitoring period was not associated with functional outcome at hospital discharge (OR 1.03 [0.93, 1.17]). Adjustment for initial rhythm, time to return of spontaneous circulation and Glasgow coma scale motor score did not significantly alter the results (OR 1.06 [0.99, 1.12]). Mean perfusion index showed a poor discriminative value with an area under the curve of 0.60 for functional outcome (0.64 for survival). Correlation between the probes was weak (Pearson coefficient 0.35).
Cerebral perfusion monitoring using a c-FLOW device in survivors of cardiac arrest is feasible, but reliability of the information provided has yet to be demonstrated. In our cohort, we were unable to identify any association between the perfusion index and clinical outcomes at discharge. As such, clinical management of cardiac arrest patients based on non-invasive perfusion index is not supported and should be limited to research protocols. The trial was registered with ClinicalTrials.gov, number NCT02575196.
确定一种新的声光技术提供的非侵入性脑灌注估计是否可作为神经功能预后的可靠预测指标。
我们对从院外心脏骤停中成功复苏的连续昏迷患者进行了一项前瞻性、观察性队列研究。患者从入住重症监护病房开始至 72 小时、完全清醒或死亡期间，使用 c-FLOW（Ornim Medical）进行监测。主要结局是出院时的良好神经功能预后，定义为脑功能表现分类评分 1 或 2。
共纳入 21 例患者，无失访。监测期间的平均灌注指数与出院时的功能结局无关（OR 1.03 [0.93, 1.17]）。调整初始节律、自主循环恢复时间和格拉斯哥昏迷量表运动评分后，结果无显著变化（OR 1.06 [0.99, 1.12]）。平均灌注指数对功能结局的区分能力较差，曲线下面积为 0.60（生存为 0.64）。探头之间的相关性较弱（Pearson 系数 0.35）。
在心脏骤停幸存者中使用 c-FLOW 设备进行脑灌注监测是可行的，但提供的信息的可靠性尚待证实。在我们的队列中，我们未能发现灌注指数与出院时临床结局之间存在任何关联。因此，基于非侵入性灌注指数的心脏骤停患者的临床管理不被支持，应仅限于研究方案。该试验在 ClinicalTrials.gov 注册，编号为 NCT02575196。
