Reichenbach Antje, Alteheld Lars, Henriksen Julia, Nakstad Espen Rostrup, Andersen Geir Øystein, Sunde Kjetil, Šaltytė Benth Jūratė, Lundqvist Christofer
Department of Neurology, Akershus University Hospital, Lørenskog, Norway.
Department of Neurology, Oslo University Hospital Ullevaal, Oslo, Norway.
Front Neurol. 2023 Oct 4;14:1222401. doi: 10.3389/fneur.2023.1222401. eCollection 2023.
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.
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.
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).
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.
院外心脏骤停后昏迷患者结局的早期预测具有挑战性。预后评估工具包括临床检查、生物标志物以及神经放射学和神经生理学检查。我们研究了经颅多普勒（TCD）与结局之间的关联。
这是前瞻性观察性挪威心肺复苏研究的一项预定义子研究。患者接受标准化的复苏后护理，包括目标温度管理（TTM）至33°C持续24小时。在第1天、第3天以及第5 - 7天进行TCD检查。主要终点是6个月时的脑功能分类（CPC），分为良好（CPC 1 - 2）和不良（CPC 3 - 5）结局。我们使用线性混合模型时间序列分析。
在139例接受TCD检查的患者中，81例（58%）结局良好。在TTM期间（第1天）大脑中动脉的收缩期峰值流速（PSV）较低，复温后（第3天）升高。此后，结局不良的患者PSV持续升高，而结局良好的患者PSV恢复正常。在第5 - 7天，结局良好的患者PSV为1.0米/秒（95%可信区间0.9；1.0），结局不良的患者PSV为1.3米/秒（95%可信区间1.1；1.4）（p < 0.001）。
第5 - 7天PSV升高表明结局不良。我们的研究结果表明，心肺复苏后第一周内进行系列TCD检查可能会增进我们对严重脑损伤的理解。
