Cerebral perfusion and metabolism with mean arterial pressure 90 vs. 60 mmHg in a porcine post cardiac arrest model with and without targeted temperature management

Abstract

Aim: To determine whether targeting a mean arterial pressure of 90 mmHg (MAP90) would yield improved cerebral blood flow and less ischaemia compared to MAP 60 mmHg (MAP60) with and without targeted temperature management at 33 C (TTM33) in a porcine post-cardiac arrest model. Methods: After 10 min of cardiac arrest, 41 swine of either sex were resuscitated until return of spontaneous circulation (ROSC). They were randomised to TTM33 or no-TTM, and MAP60 or MAP90; yielding four groups. Temperatures were managed with intravasal cooling and blood pressure targets with noradrenaline, vasopressin and nitroprusside, as appropriate. After 30 min of stabilisation, animals were observed for two hours. Cerebral perfusion pressure (CPP), cerebral blood flow (CBF), pressure reactivity index (PRx), brain tissue pCO 2 (PbtCO 2 ) and tissue intermediary metabolites were measured continuously and compared using mixed models.Results: Animals randomised to MAP90 had higher CPP (p < 0.001 for both no-TTM and TTM33) and CBF (no-TTM, p < 0.03; TH, p < 0.001) compared to MAP60 during the 150 min observational period post-ROSC. We also observed higher lactate and pyruvate in MAP60 irrespective of temperature, but no significant differences in PbtCO 2 and lactate/pyruvate-ratio. We found lower PRx (indicating more intact autoregulation) in MAP90 vs. MAP60 (no-TTM, p = 0.04; TTM33, p = 0.03). Conclusion:In this porcine cardiac arrest model, targeting MAP90 led to better cerebral perfusion and more intact autoregulation, but without clear differences in ischaemic markers, compared to MAP60.

Association between blood pressure variability and clinical outcomes after successful recanalization in patients with large vessel occlusion stroke after mechanical thrombectomy

“…The effects of inapt BP are more likely to be felt to a greater extent in the brain, which can lead to detrimental consequences ( 27 ). The 24-h postoperative MAP in this study was 89.9 mmHg, which is similar to the MAP target recommended by previous animal studies, clinical studies, and meta-analyses ( 28 – 30 ). However, the optimal mean MAP was not associated with favorable outcomes in our study.…”

Increasing mean arterial pressure or cardiac output in comatose out-of-hospital cardiac arrest patients undergoing targeted temperature management: Effects on cerebral tissue oxygenation and systemic hemodynamics

“…In a recent study of pigs, increasing MAP to 90 mmHg (compared to 60 mmHg) resulted in increased cerebral blood flow. 17 We did, however, not find increased NIRS with increasing MAP, which may be due to limitations with NIRS as a reflection of cerebral blood flow. Another study by Jakkula et al, found no association between NIRS-values and biomarkers of brain injury in patients resuscitated from OHCA.…”

Post-resuscitation diastolic blood pressure is a prognostic factor for outcomes of cardiac arrest patients: a multicenter retrospective registry-based analysis

“…The lower limit of cerebral autoregulation might become higher in post-resuscitated patients [9]. Targeting higher blood pressure (BP) might theoretically improve cerebral blood perfusion and neurologic outcomes [10]. However, current evidence is not conclusive, and several observational studies have reported controversial results [6,[11][12][13][14][15][16][17].…”