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

项目摘要 美国每年有超过50万人遭受心脏骤停（CA），其中大多数人 成功复苏的患者最终死于缺氧缺血性脑损伤。由于已有相当 在心脏骤停复苏后仍然昏迷的患者中， 迫切需要确定减少这些患者神经损伤的疗法和治疗策略。 脑灌注是CA患者复苏后神经功能预后的重要因素， 自主循环恢复（ROSC）后昏迷。因此，持续监测的能力 脑灌注和基于个体灌注目标的个性化治疗是必不可少的。的目标 本研究旨在建立猪的心脏骤停模型，并确定脑缺血对心脏骤停的影响。 基于自动调节的MAP与标准MAP靶点对脑灌注和神经损伤的影响。除了 使用扩散相关光谱学和脑血流灌注的连续光学监测 氧合作用频域近红外光谱，我们将有创监测组织氧合作用 并且还获得6小时的停搏后CT扫描以评估组织损伤的结构测量， 使用碘团动态扫描序列确认光学观察到的灌注变化。神经 将在被捕后24小时评估结果和神经损伤血清生物标志物。我们假设 使用脑自动调节的实时非侵入性测量（使用DCS）来识别和靶向脑血管疾病， 个体化最佳MAP（MAPOPT）可改善脑灌注，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.