Initial arterial carbon dioxide tension is associated with neurological outcome after resuscitation from cardiac arrest

Tolins, Molly L.; Henning, Daniel J.; Gaieski, David F.; Grossestreuer, Anne V.; Jaworski, Alison; Johnson, Nicholas J.

doi:10.1016/j.resuscitation.2017.03.006

Cited by 12 publications

(6 citation statements)

References 25 publications

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“…Instances of hypocapnia are not infrequent in low cardiac output and INTERMACS 1 or 2 patients on extracorporeal assist devices with or without dual CO 2 removal (e.g. VA-ECMO, extracorporeal cardiopulmonary resuscitation (ECPR) or CF LVAD) as well as after conventional CPR [26]. They have mostly been associated with poor neurological outcome.…”

Section: Discussionmentioning

confidence: 99%

“…Although cerebral autoregulation is frequently severely compromised after cardiopulmonary resuscitation (CPR) [24], CVR is still intact and hypocapnia can easily set in especially when shock and therapeutic hypothermia have already diminished CO 2 production. Hypocapnia post CPR, however, has been associated with poor neurological outcome, at least when it occurred within the first few hours after CPR, which unfortunately is not uncommon [25, 26].…”

Section: Introductionmentioning

confidence: 99%

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Non-pulsatile blood flow is associated with enhanced cerebrovascular carbon dioxide reactivity and an attenuated relationship between cerebral blood flow and regional brain oxygenation

et al. 2019

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BackgroundSystemic blood flow in patients on extracorporeal assist devices is frequently not or only minimally pulsatile. Loss of pulsatile brain perfusion, however, has been implicated in neurological complications. Furthermore, the adverse effects of absent pulsatility on the cerebral microcirculation are modulated similarly as CO2 vasoreactivity in resistance vessels. During support with an extracorporeal assist device swings in arterial carbon dioxide partial pressures (PaCO2) that determine cerebral oxygen delivery are not uncommon—especially when CO2 is eliminated by the respirator as well as via the gas exchanger of an extracorporeal membrane oxygenation machine. We, therefore, investigated whether non-pulsatile flow affects cerebrovascular CO2 reactivity (CVR) and regional brain oxygenation (rSO2).MethodsIn this prospective, single-centre case-control trial, we studied 32 patients undergoing elective cardiac surgery. Blood flow velocity in the middle cerebral artery (MCAv) as well as rSO2 was determined during step changes of PaCO2 between 30, 40, and 50 mmHg. Measurements were conducted on cardiopulmonary bypass during non-pulsatile and postoperatively under pulsatile blood flow at comparable test conditions. Corresponding changes of CVR and concomitant rSO2 alterations were determined for each flow mode. Each patient served as her own control.ResultsMCAv was generally lower during hypocapnia than during normocapnia and hypercapnia (p < 0.0001). However, the MCAv/PaCO2 slope during non-pulsatile flow was 14.4 cm/s/mmHg [CI 11.8–16.9] and 10.4 cm/s/mmHg [CI 7.9–13.0] after return of pulsatility (p = 0.03). During hypocapnia, non-pulsatile CVR (4.3 ± 1.7%/mmHg) was higher than pulsatile CVR (3.1 ± 1.3%/mmHg, p = 0.01). Independent of the flow mode, we observed a decline in rSO2 during hypocapnia and a corresponding rise during hypercapnia (p < 0.0001). However, the relationship between ΔrSO2 and ΔMCAv was less pronounced during non-pulsatile flow.ConclusionsNon-pulsatile perfusion is associated with enhanced cerebrovascular CVR resulting in greater relative decreases of cerebral blood flow during hypocapnia. Heterogenic microvascular perfusion may account for the attenuated ΔrSO2/ΔMCAv slope. Potential hazards related to this altered regulation of cerebral perfusion still need to be assessed.Trial registrationThe study was retrospectively registered on October 30, 2018, with Clinical Trial.gov (NCT03732651).

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Non-pulsatile blood flow is associated with enhanced cerebrovascular carbon dioxide reactivity and an attenuated relationship between cerebral blood flow and regional brain oxygenation

et al. 2019

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“…While PaCO 2 and arteriovenous PCO 2 gradients might be a more useful indicator of ventilation and cardiac output in patients undergoing CPR, evidence in people and experimental canine studies suggests that there is no significant difference in PaCO 2 between CPR survivors and nonsurvivors 54–57 . Following resuscitation from CPA, arterial normocapnia has been shown to be associated with increased odds of neurologically intact survival in people, while post‐CPA PvCO 2 values are not commonly studied as survival predictors 58–61 . Arterial blood sampling in veterinary CPA patients is challenging, and data on arterial blood gases during CPR in our study were too limited for analysis.…”

Section: Discussionmentioning

confidence: 99%

Association of point‐of‐care blood variables obtained from dogs and cats during cardiopulmonary resuscitation and following return of spontaneous circulation with patient outcomes

Hoehne

Hopper

Epstein

2022

J Vet Emergen Crit Care

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Objective: To investigate the association of point-of-care biochemical variables obtained during CPR or within 24 hours of return of spontaneous circulation (ROSC) with patient outcomes. Design: Retrospective study. Setting: University teaching hospital. Animals: Ninety-four dogs and 27 cats undergoing CPR according to the Reassessment Campaign on Veterinary Resuscitation guidelines. Interventions: None. Measurements and Main Results: Blood gas, acid-base, electrolyte, glucose, and plasma lactate values obtained during CPR or within 24 hours of ROSC were retrospectively evaluated and are described. The blood sample type and collection time with respect to CPR initiation and ROSC were recorded. Measured variables, collection times, and species were included in a multivariable logistic regression model to estimate the odds ratio (OR) and 95% confidence interval of ROSC, sustained ROSC (≥20 min), and survival to hospital discharge. Significance was set at P < 0.05. Seventytwo venous blood samples obtained during CPR and 45 first venous and arterial blood samples obtained after ROSC were included in logistic regression analysis. During CPR, PvO 2 (1.09 [1.036-1.148], P = 0.001) and venous standard base excess (SBE) (1.207 [1.094-1.331], P < 0.001) were associated with ROSC. PvO 2 (1.075 [1.028-1.124], P = 0.002), SBE (1.171 [1.013-1.353], P = 0.032), and potassium concentration (0.635 [0.426-0.946], P = 0.026) were associated with sustained ROSC. Potassium concentration (0.235 [0.083-0.667], P = 0.007) was associated with survival to hospital discharge. Following ROSC, pH (69.110 [4.393-1087], P = 0.003), potassium

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“…Some data suggest, however, that mild permissive hypercapnia is beneficial after cardiac arrest; a definitive, phase 3 randomized trial just completed enrollment. [13][14][15][16] This study has limitations. It was conducted at a single center, has a limited sample size, and began enrolling patients in 2014.…”

mentioning

confidence: 96%

“…Some data suggest, however, that mild permissive hypercapnia is beneficial after cardiac arrest; a definitive, phase 3 randomized trial just completed enrollment. 13. , 14.…”

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confidence: 99%

Don’t go breaking my…lungs? The acute respiratory distress syndrome is common, deadly, and probably underrecognized after cardiac arrest

Johnson

Town

2022

Resuscitation

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Initial arterial carbon dioxide tension is associated with neurological outcome after resuscitation from cardiac arrest

Cited by 12 publications

References 25 publications

Non-pulsatile blood flow is associated with enhanced cerebrovascular carbon dioxide reactivity and an attenuated relationship between cerebral blood flow and regional brain oxygenation

Non-pulsatile blood flow is associated with enhanced cerebrovascular carbon dioxide reactivity and an attenuated relationship between cerebral blood flow and regional brain oxygenation

Association of point‐of‐care blood variables obtained from dogs and cats during cardiopulmonary resuscitation and following return of spontaneous circulation with patient outcomes

Don’t go breaking my…lungs? The acute respiratory distress syndrome is common, deadly, and probably underrecognized after cardiac arrest

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