MD Undergraduate Program, University of British Columbia, Vancouver, BC, Canada.
Department of Anesthesiology, Pharmacology and Therapeutics, Division of Critical Care Medicine, University of British Columbia, Vancouver, BC, Canada.
Crit Care Med. 2021 Aug 1;49(8):1333-1346. doi: 10.1097/CCM.0000000000004945.
Following return of spontaneous circulation after cardiac arrest, hypoxic ischemic brain injury is the primary cause of mortality and disability. Goal-directed care using invasive multimodal neuromonitoring has emerged as a possible resuscitation strategy. We evaluated whether goal-directed care was associated with improved neurologic outcome in hypoxic ischemic brain injury patients after cardiac arrest.
Retrospective, single-center, matched observational cohort study.
Quaternary academic medical center.
Adult patients admitted to the ICU following return of spontaneous circulation postcardiac arrest with clinical evidence of hypoxic ischemic brain injury defined as greater than or equal to 10 minutes of cardiac arrest with an unconfounded postresuscitation Glasgow Coma Scale of less than or equal to 8.
We compared patients who underwent goal-directed care using invasive neuromonitoring with those treated with standard of care (using both total and matched groups).
Goal-directed care patients were matched 1:1 to standard of care patients using propensity scores and exact matching. The primary outcome was a 6-month favorable neurologic outcome (Cerebral Performance Category of 1 or 2). We included 65 patients, of whom 21 received goal-directed care and 44 patients received standard of care. The median age was 50 (interquartile range, 35-61), 48 (74%) were male, and seven (11%) had shockable rhythms. Favorable neurologic outcome at 6 months was significantly greater in the goal-directed care group (n = 9/21 [43%]) compared with the matched (n = 2/21 [10%], p = 0.016) and total (n = 8/44 [18%], p = 0.034) standard of care groups. Goal-directed care group patients had higher mean arterial pressure (p < 0.001 vs total; p = 0.0060 vs matched) and lower temperature (p = 0.007 vs total; p = 0.041 vs matched).
In this preliminary study of patients with hypoxic ischemic brain injury postcardiac arrest, goal-directed care guided by invasive neuromonitoring was associated with a 6-month favorable neurologic outcome (Cerebral Performance Category 1 or 2) versus standard of care. Significant work is required to confirm this finding in a prospectively designed study.
心脏骤停后，缺氧缺血性脑损伤是导致死亡和残疾的主要原因。使用有创多模态神经监测的目标导向治疗已成为一种可能的复苏策略。我们评估了心脏骤停后缺氧缺血性脑损伤患者的目标导向治疗是否与神经功能结局改善相关。
回顾性、单中心、匹配的观察性队列研究。
四级学术医疗中心。
接受心脏骤停后自主循环恢复并伴有缺氧缺血性脑损伤临床证据的成年患者，定义为心脏骤停时间大于或等于 10 分钟且无混杂因素，且复苏后格拉斯哥昏迷量表评分小于或等于 8。
我们比较了使用有创神经监测进行目标导向治疗的患者与接受标准治疗的患者（使用总组和匹配组）。
使用倾向评分和精确匹配，将目标导向治疗患者与标准治疗患者 1:1 匹配。主要结局是 6 个月时的良好神经功能结局（脑功能预后评分 1 或 2）。我们纳入了 65 例患者，其中 21 例接受目标导向治疗，44 例接受标准治疗。中位年龄为 50 岁（四分位间距，35-61 岁），48 例（74%）为男性，7 例（11%）有可除颤性节律。与匹配组（n = 2/21 [10%]，p = 0.016）和总组（n = 8/44 [18%]，p = 0.034）相比，目标导向治疗组（n = 9/21 [43%]）6 个月时的良好神经功能结局显著更高。目标导向治疗组的平均动脉压更高（与总组相比，p < 0.001；与匹配组相比，p = 0.0060），体温更低（与总组相比，p = 0.007；与匹配组相比，p = 0.041）。
在这项心脏骤停后缺氧缺血性脑损伤患者的初步研究中，与标准治疗相比，有创神经监测指导的目标导向治疗与 6 个月时的良好神经功能结局（脑功能预后评分 1 或 2）相关。需要进行大量工作以在前瞻性设计的研究中证实这一发现。
