Section of Pediatric Neurosurgery, Department of Neurosurgery, University Hospital of Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany.
Department of Spine Surgery, Isar Klinikum, Sonnenstr. 24-26, Munich, Germany.
Childs Nerv Syst. 2022 Sep;38(9):1717-1726. doi: 10.1007/s00381-022-05579-4. Epub 2022 Jun 9.
Impaired cerebral blood flow is a first-line reason of ischemic-hypoxic brain injury in children. The principal goal of intensive care management is to detect and prevent further cerebral blood flow deficits. This can be achieved by actively managing cerebral perfusion pressure (CPP) using input from cerebrovascular autoregulation (CAR). The main objective of the current study was to investigate CAR after cardiac arrest in children.
Nineteen consecutive children younger than 18 years after cardiopulmonary resuscitation, in whom intracranial pressure (ICP) was continuously measured, were included. Blood pressure and ICP were continuously monitored via ICM + software and actively managed using the pressure reactivity index (PRx) to achieve and maintain an optimal CPP. Outcome was scored using the extended Glasgow outcome scale (eGOS) at discharge and 6 months.
Eight children died in hospital. At 6 months, further 4 children had an unfavorable (eGOS1-4) and 7 a favorable (eGOS5-8) outcome. Over the entire monitoring period, we found an elevated ICP (24.5 vs 7.4 mmHg), a lower CPP (50.3 vs 66.2 mmHg) and a higher PRx (0.24 vs - 0.01), indicating impaired CAR, in patients with unfavorable outcome. The dose of impaired autoregulation was significantly higher in unfavorable outcome (54.6 vs 29.3%). Analyzing only the first 72 h after cardiac arrest, ICP ≥ 10 mmHg and PRx > 0.2 correlated to unfavorable outcome.
Significant doses of impaired CAR within 72 h after resuscitation are associated with unfavorable outcome. The inability to restore autoregulation despite active attempts to do so as well as an elevated ICP may serve as a bad prognostic sign indicating a severe initial hypoxic-ischemic brain injury.
脑血流减少是儿童缺血缺氧性脑损伤的首要原因。重症监护管理的主要目标是通过检测和预防进一步的脑血流减少来发现和预防。这可以通过使用脑血管自动调节（CAR）的输入来积极管理脑灌注压（CPP）来实现。本研究的主要目的是研究儿童心脏骤停后的 CAR。
纳入了 19 名心肺复苏后年龄小于 18 岁的连续儿童，他们的颅内压（ICP）持续测量，血压和 ICP 通过 ICM + 软件连续监测，并使用压力反应性指数（PRx）积极管理以实现和维持最佳 CPP。出院和 6 个月时使用扩展格拉斯哥结局量表（eGOS）进行结局评分。
8 名儿童在医院死亡。6 个月时，4 名儿童预后不良（eGOS1-4），7 名儿童预后良好（eGOS5-8）。在整个监测期间，我们发现预后不良的患者 ICP 升高（24.5 对 7.4mmHg）、CPP 降低（50.3 对 66.2mmHg）和 PRx 升高（0.24 对 -0.01），表明 CAR 受损。预后不良患者的受损自动调节剂量明显更高（54.6 对 29.3%）。仅分析心脏骤停后 72 小时，ICP≥10mmHg 和 PRx>0.2 与不良预后相关。
复苏后 72 小时内存在明显剂量的受损 CAR 与不良预后相关。尽管积极尝试恢复自动调节，但仍无法恢复自动调节以及 ICP 升高可能是预后不良的不良预后标志，表明初始缺氧缺血性脑损伤严重。
