Noninvasive neuromonitoring to guide hemodynamic optimization of cerebral perfusion after return of spontaneous circulation in a swine model of cardiac arrest

项目总结 在美国，每年有超过50万人遭受心脏骤停(CA)，而且大多数人 成功复苏的患者最终死于缺氧缺血性脑损伤。考虑到大量的 心脏骤停复苏后仍处于昏迷状态的患者的神经系统发病率和死亡率 迫切需要确定治疗方法和治疗策略，以减少这些患者的神经损伤。 脑血流灌注是影响复苏后CA患者神经系统预后的重要因素 自主循环恢复后昏迷(ROSC)。因此，持续监控的能力 脑灌注和基于个体化灌注靶点的个体化治疗是必不可少的。的目标是 这项建议是为了建立猪心脏骤停模型，并确定使用脑组织的影响 基于自动调节的MAP靶点与标准MAP靶点在脑血流灌注和神经损伤方面的比较。除了…之外 弥散相关光谱脑血流连续光学监测及脑血流动力学研究 氧合利用频域近红外光谱，我们将对组织氧合进行侵入性监测 并于术后6小时行CT扫描，评价组织损伤的结构性措施 使用碘丸动态扫描序列确认光学观察到的血流灌注变化。神经科 结果和神经损伤血清生物标记物将在停搏后24小时进行评估。我们假设 使用脑自动调节的实时无创测量(使用分布式控制系统)来识别和靶向AN 个体化最佳MAP(MAPOPT)将改善脑血流灌注，减少术后神经损伤 心脏骤停复苏。

PROJECT SUMMARY More than 500,000 people in the United States suffer a sudden cardiac arrest (CA) each year, and most successfully resuscitated patients ultimately die from hypoxic ischemic brain injury. Given the substantial neurologic morbidity and mortality in patients who remain comatose following resuscitated cardiac arrest, there is a critical need to identify therapies and treatment strategies to reduce neurologic injury in these patients. Cerebral perfusion is an important contributor to neurologic outcomes in resuscitated CA patients who remain comatose following return of spontaneous circulation (ROSC). Therefore, the ability to continuously monitor cerebral perfusion and personalize treatment based on individual perfusion targets is essential. The objective of this proposal is to create a swine cardiac arrest model, and to determine the impact of using cerebral autoregulation-based vs standard MAP targets on cerebral perfusion and neurologic injury. In additional to continuous optical monitoring of cerebral perfusion using diffuse correlation spectroscopy and of cerebral oxygenation using frequency domain near infrared spectrometry, we will invasively monitor tissue oxygenation and perfusion and also obtain 6 hours post-arrest CT scans to evaluate structural measures of tissue injury to confirm optically observed perfusion changes using iodine bolus dynamic scan sequences. Neurological outcomes and neural injury serum biomarkers will be assessed 24 hours post-arrest. We hypothesize that the use of real-time noninvasive measures of cerebral autoregulation (using DCS) to identify and target an individualized optimal MAP (MAPOPT) will improve cerebral perfusion and decrease neurologic injury after a resuscitated cardiac arrest.