Meunier Juliette, Engrand Nicolas, Saulnier Patrick, Deye Nicolas, Landais Mickaël, Cariou Alain, Guitton Christophe, Chudeau Nicolas
Intensive Care Unit, Le Mans Hospital, Le Mans, France.
Anaesthesia and Neuro-critical Care, Rothschild Foundation Hospital, Paris, France.
Resusc Plus. 2025 Jun 14;25:101001. doi: 10.1016/j.resplu.2025.101001. eCollection 2025 Sep.
Hypoxic Ischemic Brain Injury is a major cause of death after cardiac arrest. Identifying optimal mean arterial pressure (MAP) targets to restore brain oxygen delivery remains challenging. This study assessed the feasibility of using transcranial Doppler to guide individualised MAP management in post-cardiac arrest patients.
In this single-centre prospective feasibility study, post-cardiac arrest patients were enrolled after intensive care unit admission. After induction of targeted temperature management (TTM) and control of systemic secondary brain insults determinants, cerebral hypoperfusion was screened using transcranial Doppler. A MAP challenge was performed in patients with abnormal transcranial Doppler findings to assess cerebral vascular responsiveness to increased MAP. Jugular bulb oximetry was concurrently used to evaluate cerebral oxygenation.
A total of 172 patients were screened, and 20 (11.6%) were assessable using transcranial Doppler. After optimisation of cerebral blood flow determinants, 3 patients (15%) showed signs of cerebral hypoperfusion based on transcranial Doppler measurements. A MAP challenge was performed in two of these patients, without normalisation of transcranial Doppler values and with an estimated increase in intracranial pressure. No significant association was found between transcranial Doppler findings and either cerebral oxygenation parameters or neurological outcome. Baseline SjvO levels were paradoxically higher in non-survivors.
Implementing an individualised MAP management strategy guided by transcranial Doppler was challenging, with few patients eligible for evaluation. Still, transcranial Doppler identified a small group with persistent cerebral hypoperfusion despite optimised cerebral blood flow parameters. The study underscored technical and physiological limitations of this approach, which should inform the design and relevance of a larger trial to assess its clinical value.Trial registration: https://www.clinicaltrials.gov NCT04000334.
缺氧缺血性脑损伤是心脏骤停后死亡的主要原因。确定恢复脑氧输送的最佳平均动脉压（MAP）目标仍然具有挑战性。本研究评估了使用经颅多普勒指导心脏骤停后患者个体化MAP管理的可行性。
在这项单中心前瞻性可行性研究中，心脏骤停后患者在入住重症监护病房后入组。在诱导目标温度管理（TTM）并控制全身性继发性脑损伤决定因素后，使用经颅多普勒筛查脑灌注不足情况。对经颅多普勒检查结果异常的患者进行MAP挑战，以评估脑血管对MAP升高的反应性。同时使用颈静脉球血氧饱和度测定法评估脑氧合情况。
共筛查了172例患者，其中20例（11.6%）可使用经颅多普勒进行评估。在优化脑血流决定因素后，3例患者（15%）经颅多普勒测量显示存在脑灌注不足迹象。对其中2例患者进行了MAP挑战，经颅多普勒值未恢复正常，且颅内压估计有所升高。经颅多普勒检查结果与脑氧合参数或神经功能结局之间未发现显著关联。非幸存者的基线颈静脉球血氧饱和度（SjvO）水平反而更高。
实施以经颅多普勒为指导的个体化MAP管理策略具有挑战性，符合评估条件的患者很少。尽管如此，经颅多普勒仍识别出一小部分患者，尽管脑血流参数已优化，但仍存在持续性脑灌注不足。该研究强调了这种方法在技术和生理方面的局限性，这应为评估其临床价值的更大规模试验的设计和相关性提供参考。试验注册：https://www.clinicaltrials.gov NCT04000334 。
