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Determining Optimal Mean Arterial Pressure After Cardiac Arrest: A Systematic Review.
Rikhraj, Kiran J K; Wood, Michael D; Hoiland, Ryan L; Thiara, Sharanjit; Griesdale, Donald E G; Sekhon, Mypinder S.
Afiliación
  • Rikhraj KJK; Department of Emergency Medicine, Faculty of Medicine, Vancouver General Hospital, University of British Columbia, Room 2438, Jim Pattison Pavilion, 2nd Floor, 899 West 12th Avenue, Vancouver, BC, V5Z 1M9, Canada. kiran94jkr@gmail.com.
  • Wood MD; Department of Anaesthesiology, Pharmacology and Therapeutics, Faculty of Medicine, Vancouver General Hospital, University of British Columbia, 899 West 12th Avenue, Vancouver, BC, V5Z 1M9, Canada.
  • Hoiland RL; Department of Anaesthesiology, Pharmacology and Therapeutics, Faculty of Medicine, Vancouver General Hospital, University of British Columbia, 899 West 12th Avenue, Vancouver, BC, V5Z 1M9, Canada.
  • Thiara S; Centre for Heart, Lung, and Vascular Health, School of Health and Exercise Sciences, University of British Columbia Okanagan, 3333 University Way, Kelowna, BC, V1V1V7, Canada.
  • Griesdale DEG; Division of Critical Care Medicine, Department of Medicine, Faculty of Medicine, Vancouver General Hospital, University of British Columbia, 899 West 12th Avenue, Vancouver, BC, V5Z 1M9, Canada.
  • Sekhon MS; Department of Anaesthesiology, Pharmacology and Therapeutics, Faculty of Medicine, Vancouver General Hospital, University of British Columbia, 899 West 12th Avenue, Vancouver, BC, V5Z 1M9, Canada.
Neurocrit Care ; 34(2): 621-634, 2021 04.
Article en En | MEDLINE | ID: mdl-32572823
The use of cerebral autoregulation monitoring to identify patient-specific optimal mean arterial pressure (MAPOPT) has emerged as a technique to augment cerebral oxygen delivery in post-cardiac arrest patients. Our systematic review aims to determine (a) the average MAPOPT in these patients, (b) the feasibility of identifying MAPOPT, (c) the brain tissue oxygenation levels when MAP is within proximity to the MAPOPT and (d) the relationship between neurological outcome and MAPOPT-targeted resuscitation strategies. We carried out this review in accordance with the PRISMA guidelines. We included all studies that used cerebral autoregulation to determine MAPOPT in adult patients (> 16 years old) who achieved return of spontaneous circulation (ROSC) following cardiac arrest. All studies had to include our primary outcome of MAPOPT. We excluded studies where the patients had any history of traumatic brain injury, ischemic stroke or intracranial hemorrhage. We identified six studies with 181 patients. There was wide variability in cerebral autoregulation monitoring methods, length of monitoring, calculation and reporting of MAPOPT. Amongst all studies, the median or mean MAPOPT was consistently above 65 mmHg (range 70-114 mmHg). Definitions of feasibility varied among studies and were difficult to summarize. Only one study noted that brain tissue oxygenation increased as patients' MAP approached MAPOPT. There was no consistent association between targeting MAPOPT and improved neurological outcome. There is considerable heterogeneity in MAPOPT due to differences in monitoring methods of autoregulation. Further research is needed to assess the clinical utility of MAPOPT-guided strategies on decreasing secondary injury and improving neurological outcomes after ROSC.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Hipoxia-Isquemia Encefálica / Paro Cardíaco Tipo de estudio: Guideline / Prognostic_studies / Systematic_reviews Límite: Adult / Humans Idioma: En Revista: Neurocrit Care Asunto de la revista: NEUROLOGIA / TERAPIA INTENSIVA Año: 2021 Tipo del documento: Article País de afiliación: Canadá Pais de publicación: Estados Unidos
Texto completo
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Hipoxia-Isquemia Encefálica / Paro Cardíaco Tipo de estudio: Guideline / Prognostic_studies / Systematic_reviews Límite: Adult / Humans Idioma: En Revista: Neurocrit Care Asunto de la revista: NEUROLOGIA / TERAPIA INTENSIVA Año: 2021 Tipo del documento: Article País de afiliación: Canadá Pais de publicación: Estados Unidos