A randomized, double-blind trial comparing the effect of two blood pressure targets on global brain metabolism after out-of-hospital cardiac arrest.
Arterial pressure
Brain injury
Cerebral metabolism
Jugular bulb microdialysis
Out-of-hospital cardiac arrest
Journal
Critical care (London, England)
ISSN: 1466-609X
Titre abrégé: Crit Care
Pays: England
ID NLM: 9801902
Informations de publication
Date de publication:
24 02 2023
24 02 2023
Historique:
received:
16
12
2022
accepted:
20
02
2023
entrez:
24
2
2023
pubmed:
25
2
2023
medline:
3
3
2023
Statut:
epublish
Résumé
This study aimed to assess the effect of different blood pressure levels on global cerebral metabolism in comatose patients resuscitated from out-of-hospital cardiac arrest (OHCA). In a double-blinded trial, we randomly assigned 60 comatose patients following OHCA to low (63 mmHg) or high (77 mmHg) mean arterial blood pressure (MAP). The trial was a sub-study in the Blood Pressure and Oxygenation Targets after Out-of-Hospital Cardiac Arrest-trial (BOX). Global cerebral metabolism utilizing jugular bulb microdialysis (JBM) and cerebral oxygenation (rSO We found a clear separation in MAP between the groups (15 mmHg, p < 0.001). Cerebral biochemical variables were not significantly different between MAP groups (LPR low MAP 19 (16-31) vs. high MAP 23 (16-33), p = 0.64). However, the LP ratio remained high (> 16) in both groups during the first 30 h. During the first 24 h, cerebral lactate > 2.5 mM, pyruvate levels > 110 µM, LP ratio > 30, and glycerol > 260 µM were highly predictive for poor neurological outcome and death with AUC 0.80. The median (IQR) rSO Among comatose patients resuscitated from OHCA, targeting a higher MAP 180 min after ROSC did not significantly improve cerebral energy metabolism within 96 h of post-resuscitation care. Patients with a poor clinical outcome exhibited significantly worse biochemical patterns, probably illustrating that insufficient tissue oxygenation and recirculation during the initial hours after ROSC were essential factors determining neurological outcome.
Identifiants
pubmed: 36823636
doi: 10.1186/s13054-023-04376-y
pii: 10.1186/s13054-023-04376-y
pmc: PMC9951410
doi:
Substances chimiques
Lactates
0
Pyruvates
0
Types de publication
Journal Article
Randomized Controlled Trial
Langues
eng
Sous-ensembles de citation
IM
Pagination
73Informations de copyright
© 2023. The Author(s).
Références
J Crit Care. 2014 Dec;29(6):1130.e5-9
pubmed: 25012960
Intensive Care Med. 2021 Apr;47(4):369-421
pubmed: 33765189
J Cardiothorac Vasc Anesth. 2017 Aug;31(4):1166-1173
pubmed: 28089142
Brain Res. 2010 Apr 30;1328:181-9
pubmed: 20211610
Brain Res. 1974 Jun 20;73(2):291-307
pubmed: 4831084
Resuscitation. 2017 Jan;110:85-89
pubmed: 27840005
Intensive Care Med. 2021 Dec;47(12):1393-1414
pubmed: 34705079
J Neurol Neurosurg Psychiatry. 1998 Apr;64(4):486-91
pubmed: 9576540
Acta Physiol Scand. 1978 Nov;104(3):271-80
pubmed: 716981
Resuscitation. 2015 May;90:121-6
pubmed: 25769511
J Biomed Inform. 2009 Apr;42(2):377-81
pubmed: 18929686
Brain. 2011 Feb;134(Pt 2):484-94
pubmed: 21247930
Intensive Care Med Exp. 2019 Dec 4;7(1):67
pubmed: 31802303
Crit Care. 2017 Apr 13;21(1):90
pubmed: 28403909
J Cereb Blood Flow Metab. 2021 Apr;41(4):771-779
pubmed: 32501157
Neurology. 2016 Apr 19;86(16):1482-90
pubmed: 26865516
Acta Anaesthesiol Scand. 2013 Jul;57(6):793-801
pubmed: 23495747
Acta Physiol Scand. 1975 Apr;93(4):569-71
pubmed: 1155154
Clin Sci (Lond). 1994 Feb;86(2):177-84
pubmed: 8143428
Front Neurol. 2022 Aug 10;13:968288
pubmed: 36034291
Crit Care. 2017 Apr 13;21(1):96
pubmed: 28410590
Intensive Care Med. 2015 Sep;41(9):1517-28
pubmed: 26194024
Eur Heart J. 2019 Jun 7;40(22):1804-1814
pubmed: 30895296
Sci Rep. 2021 Aug 5;11(1):15871
pubmed: 34354178
Crit Care Med. 2020 Mar;48(3):378-384
pubmed: 31789834
N Engl J Med. 2013 Dec 5;369(23):2197-206
pubmed: 24237006
Neurol Clin. 2021 May;39(2):273-292
pubmed: 33896519
Intensive Care Med. 2013 Nov;39(11):1972-80
pubmed: 23942856
Lancet. 2021 Oct 2;398(10307):1269-1278
pubmed: 34454687
Trials. 2022 Feb 24;23(1):177
pubmed: 35209951
N Engl J Med. 2022 Oct 20;387(16):1467-1476
pubmed: 36027567
Resuscitation. 2020 Nov;156:280-281
pubmed: 32858154
Trials. 2019 Jun 10;20(1):344
pubmed: 31182135
N Engl J Med. 2022 Oct 20;387(16):1456-1466
pubmed: 36027564
J Am Heart Assoc. 2015 Sep 14;4(9):e002232
pubmed: 26370446
Resuscitation. 2017 Dec;121:179-186
pubmed: 28947390
Intensive Care Med. 2018 Dec;44(12):2091-2101
pubmed: 30443729
Resuscitation. 2014 Aug;85(8):1037-41
pubmed: 24795284
Acta Anaesthesiol Scand. 2009 Mar;53(3):289-98
pubmed: 19243314
Lancet. 1994 Apr 30;343(8905):1055-9
pubmed: 7909098
Resuscitation. 2021 Oct;167:251-260
pubmed: 34166747
Resuscitation. 2020 Mar 1;148:218-226
pubmed: 32027980
Resuscitation. 2020 Jul;152:184-191
pubmed: 32229218
J Clin Endocrinol Metab. 1993 Feb;76(2):392-8
pubmed: 8381801
Intensive Care Med Exp. 2016 Dec;4(1):3
pubmed: 26791144
Crit Care. 2019 May 14;23(1):171
pubmed: 31088512
Stroke. 2001 Jan;32(1):128-32
pubmed: 11136927
Stroke. 1979 Jul-Aug;10(4):437-46
pubmed: 505482
Adv Exp Med Biol. 1992;318:41-56
pubmed: 1636506
Circ Res. 2021 Aug 20;129(5):583-597
pubmed: 34287000
Resuscitation. 2017 May;114:79-82
pubmed: 28279695
Brain Res. 1975 Mar 14;86(1):31-44
pubmed: 234773
Neurosurgery. 2000 Sep;47(3):701-9; discussion 709-10
pubmed: 10981758
Intensive Care Med. 2020 Oct;46(10):1969-1971
pubmed: 32761448
Crit Care Med. 2018 Oct;46(10):1626-1633
pubmed: 29994882
Crit Care Med. 2019 Jul;47(7):960-969
pubmed: 30889022
J Am Coll Cardiol. 2015 May 19;65(19):2104-14
pubmed: 25975474
Eur Heart J Acute Cardiovasc Care. 2020 Nov;9(4_suppl):S138-S144
pubmed: 30854867
Oxid Med Cell Longev. 2019 Nov 11;2019:4028394
pubmed: 31814874
Neurocrit Care. 2012 Aug;17(1):49-57
pubmed: 22528283
J Neurochem. 1978 Feb;30(2):479-86
pubmed: 624953
Neurocrit Care. 2020 Aug;33(1):241-255
pubmed: 31845174
Resuscitation. 2015 Jun;91:56-62
pubmed: 25828921
Resuscitation. 2021 Nov;168:199-205
pubmed: 34461205
Brain Res. 1974 Jun 20;73(2):277-89
pubmed: 4831083
Resuscitation. 2016 Mar;100:6-10
pubmed: 26744101