Non-invasive cerebral perfusion monitoring in cardiac arrest patients: a prospective cohort study
Non-invasive cerebral perfusion monitoring in cardiac arrest patients: a prospective cohort study
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DOI：
10.1016/j.clineuro.2020.105970
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发表时间：
2020-09-01
影响因子：
1.9
通讯作者：
Mayer, Stephan A.
中科院分区：
文献类型：
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作者：
Francoeur, Charles L.;Lee, James;Mayer, Stephan A.
目的：确定一种新的声光技术提供的无创脑血流灌注评估是否可以作为神经预后的可靠预测指标。患者和方法：我们对连续从院外心脏骤停成功复苏的昏迷患者进行了前瞻性、观察性队列研究。使用c-Flow(ORNIM Medical)监测患者从重症监护病房入院到72小时、完全苏醒或死亡。主要结果是出院时良好的神经预后，定义为脑功能分类评分为1或2。结果：共有21名患者入选，无一例失访。监测期间的平均血流灌注指数与出院时的功能结果无关(OR 1.03[0.93，1.17])。调整初始节律、自主循环恢复时间和格拉斯哥昏迷评分对结果无显著影响(OR1.06[0.99，1.12])。平均血流灌注指数对功能预后的判别价值较差，曲线下面积为0.60(0.64表示存活)。探头之间的相关性很弱(皮尔逊系数0.35)。结论：在心脏骤停幸存者中使用C-Flow设备进行脑血流灌注监测是可行的，但所提供信息的可靠性尚未得到证实。在我们的队列中，我们无法确定出院时血流灌注指数和临床结果之间的任何联系。因此，基于非侵入性血流灌注指数的心脏骤停患者的临床治疗不受支持，应仅限于研究方案。该试验在ClinicalTrials.gov注册，编号为NCT02575196。
Objectives: To determine if non-invasive cerebral perfusion estimation provided by a new acousto-optic technology can be used as a reliable predictor of neurological outcome.Patients and Methods: We performed a prospective, observational cohort study of consecutive comatose patients successfully resuscitated from out-of-hospital cardiac arrest. Patients were monitored using c-FLOW (Ornim Medical) from critical care unit admission up to 72 h, full awakening, or death. Primary outcome was favourable neurological outcome at hospital discharge, defined as a Cerebral Performance Category score of 1 or 2.Results: A total of 21 patients were enrolled, without any loss to follow-up. Mean perfusion index over the monitoring period was not associated with functional outcome at hospital discharge (OR 1.03 [0.93, 1.17]). Adjustment for initial rhythm, time to return of spontaneous circulation and Glasgow coma scale motor score did not significantly alter the results (OR 1.06 [0.99, 1.12]). Mean perfusion index showed a poor discriminative value with an area under the curve of 0.60 for functional outcome (0.64 for survival). Correlation between the probes was weak (Pearson coefficient 0.35).Conclusion: Cerebral perfusion monitoring using a c-FLOW device in survivors of cardiac arrest is feasible, but reliability of the information provided has yet to be demonstrated. In our cohort, we were unable to identify any association between the perfusion index and clinical outcomes at discharge. As such, clinical management of cardiac arrest patients based on non-invasive perfusion index is not supported and should be limited to research protocols. The trial was registered with ClinicalTrials.gov, number NCT02575196.