{"title":"院外心脏骤停后颅内血液动力学和压力的超声评估:TAME试验的一项探索性子研究","authors":"","doi":"10.1016/j.ccrj.2024.06.001","DOIUrl":null,"url":null,"abstract":"<div><h3>Objective</h3><p>Targeted mild hypercapnia is a potential neuroprotective therapy after cardiac arrest. In this exploratory observational study, we aimed to explore the effects of targeted mild hypercapnia on cerebral microvascular resistance assessed by middle cerebral artery pulsatility index (MCA PI) and intracranial pressure estimated by optic nerve sheath diameter (ONSD) in resuscitated out-of-hospital cardiac arrest (OHCA) patients.</p></div><div><h3>Design, setting, participants and interventions</h3><p>Comatose adults resuscitated from OHCA were randomly allocated to targeted mild hypercapnia (PaCO<sub>2</sub> 50–55 mmHg) or targeted normocapnia (PaCO<sub>2</sub> 35–45 mmHg) for 24 h in the TAME trial.</p></div><div><h3>Main outcome measures</h3><p>Using transcranial Doppler and transorbital ultrasound, we obtained MCA PI and ONSD at 4, 24, and 48 h after randomization. Ultrasound parameters were compared between groups using a linear mixed effects model.</p></div><div><h3>Results</h3><p>Twelve consecutive patients were included, with seven patients in the mild hypercapnia group. MCA PI decreased from 4 to 24 h (p = 0.019) and was lower over the first 24 h in patients allocated to targeted mild hypercapnia compared with targeted normocapnia (p = 0.047). ONSD did not differ between groups or over time.</p></div><div><h3>Conclusion</h3><p>Cerebral microvascular resistance assessed by MCA PI decreased over 24 h and was lower in OHCA patients treated with targeted mild hypercapnia compared with targeted normocapnia. Targeted mild hypercapnia did not exert substantial effect on intracranial pressure as estimated by ONSD.</p></div>","PeriodicalId":49215,"journal":{"name":"Critical Care and Resuscitation","volume":null,"pages":null},"PeriodicalIF":1.4000,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1441277224000164/pdfft?md5=f7af3cbe49d6aa5ac5495abd615c7474&pid=1-s2.0-S1441277224000164-main.pdf","citationCount":"0","resultStr":"{\"title\":\"Sonographic evaluation of intracranial hemodynamics and pressure after out-of-hospital cardiac arrest: An exploratory sub-study of the TAME trial\",\"authors\":\"\",\"doi\":\"10.1016/j.ccrj.2024.06.001\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Objective</h3><p>Targeted mild hypercapnia is a potential neuroprotective therapy after cardiac arrest. In this exploratory observational study, we aimed to explore the effects of targeted mild hypercapnia on cerebral microvascular resistance assessed by middle cerebral artery pulsatility index (MCA PI) and intracranial pressure estimated by optic nerve sheath diameter (ONSD) in resuscitated out-of-hospital cardiac arrest (OHCA) patients.</p></div><div><h3>Design, setting, participants and interventions</h3><p>Comatose adults resuscitated from OHCA were randomly allocated to targeted mild hypercapnia (PaCO<sub>2</sub> 50–55 mmHg) or targeted normocapnia (PaCO<sub>2</sub> 35–45 mmHg) for 24 h in the TAME trial.</p></div><div><h3>Main outcome measures</h3><p>Using transcranial Doppler and transorbital ultrasound, we obtained MCA PI and ONSD at 4, 24, and 48 h after randomization. Ultrasound parameters were compared between groups using a linear mixed effects model.</p></div><div><h3>Results</h3><p>Twelve consecutive patients were included, with seven patients in the mild hypercapnia group. MCA PI decreased from 4 to 24 h (p = 0.019) and was lower over the first 24 h in patients allocated to targeted mild hypercapnia compared with targeted normocapnia (p = 0.047). ONSD did not differ between groups or over time.</p></div><div><h3>Conclusion</h3><p>Cerebral microvascular resistance assessed by MCA PI decreased over 24 h and was lower in OHCA patients treated with targeted mild hypercapnia compared with targeted normocapnia. 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引用次数: 0
摘要
目的有针对性的轻度高碳酸血症是心脏骤停后一种潜在的神经保护疗法。在这项探索性观察研究中,我们旨在探讨有针对性的轻度高碳酸血症对院外心脏骤停(OHCA)复苏患者大脑中动脉搏动指数(MCA PI)评估的脑微血管阻力和视神经鞘直径(ONSD)估测的颅内压的影响。设计、环境、参与者和干预措施在 TAME 试验中,院外心脏骤停(OHCA)复苏的成人患者被随机分配到目标性轻度高碳酸血症(PaCO2 50-55 mmHg)或目标性正常碳酸血症(PaCO2 35-45 mmHg)治疗 24 小时。主要结果测量通过经颅多普勒和经眶超声,我们在随机分配后的 4、24 和 48 小时获得了 MCA PI 和 ONSD。采用线性混合效应模型比较了不同组间的超声参数。从 4 小时到 24 小时,MCA PI 有所下降(p = 0.019),与正常碳酸血症组相比,轻度高碳酸血症组患者的 MCA PI 在前 24 小时内更低(p = 0.047)。结论 通过 MCA PI 评估的脑微血管阻力在 24 小时内有所下降,与正常碳酸血症相比,定向轻度高碳酸血症治疗的 OHCA 患者的脑微血管阻力更低。有针对性的轻度高碳酸血症并未对ONSD估测的颅内压产生实质性影响。
Sonographic evaluation of intracranial hemodynamics and pressure after out-of-hospital cardiac arrest: An exploratory sub-study of the TAME trial
Objective
Targeted mild hypercapnia is a potential neuroprotective therapy after cardiac arrest. In this exploratory observational study, we aimed to explore the effects of targeted mild hypercapnia on cerebral microvascular resistance assessed by middle cerebral artery pulsatility index (MCA PI) and intracranial pressure estimated by optic nerve sheath diameter (ONSD) in resuscitated out-of-hospital cardiac arrest (OHCA) patients.
Design, setting, participants and interventions
Comatose adults resuscitated from OHCA were randomly allocated to targeted mild hypercapnia (PaCO2 50–55 mmHg) or targeted normocapnia (PaCO2 35–45 mmHg) for 24 h in the TAME trial.
Main outcome measures
Using transcranial Doppler and transorbital ultrasound, we obtained MCA PI and ONSD at 4, 24, and 48 h after randomization. Ultrasound parameters were compared between groups using a linear mixed effects model.
Results
Twelve consecutive patients were included, with seven patients in the mild hypercapnia group. MCA PI decreased from 4 to 24 h (p = 0.019) and was lower over the first 24 h in patients allocated to targeted mild hypercapnia compared with targeted normocapnia (p = 0.047). ONSD did not differ between groups or over time.
Conclusion
Cerebral microvascular resistance assessed by MCA PI decreased over 24 h and was lower in OHCA patients treated with targeted mild hypercapnia compared with targeted normocapnia. Targeted mild hypercapnia did not exert substantial effect on intracranial pressure as estimated by ONSD.
期刊介绍:
ritical Care and Resuscitation (CC&R) is the official scientific journal of the College of Intensive Care Medicine (CICM). The Journal is a quarterly publication (ISSN 1441-2772) with original articles of scientific and clinical interest in the specialities of Critical Care, Intensive Care, Anaesthesia, Emergency Medicine and related disciplines.
The Journal is received by all Fellows and trainees, along with an increasing number of subscribers from around the world.
The CC&R Journal currently has an impact factor of 3.3, placing it in 8th position in world critical care journals and in first position in the world outside the USA and Europe.