Modificaciones en la velocidad de flujo cerebral medidas mediante Doppler transcraneal, tras maniobras de soporte vital avanzado

Puertas, Agustín Carlos Nebra; Señor, B. Virgós; Pinilla, Miguel; Hinojosa, J. Munárriz; Sáez, Rafael; Miret, J. I. Sánchez; Camacho, Francisco Gómez; Benito, A. Millastre

doi:10.1016/s0210-5691(03)79901-x

Cited by 5 publications

(3 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…En los pacientes que permanecen en coma al menos 20 min tras recuperarse de una PC, el patrón DTC predominante incluye Vm bajas e IP altos, reflejo del estado de trombosis y vasoespasmo de la microcirculación cerebral; en ausencia de complicaciones, estos valores tenderían a normalizarse a las 72 h, pero sin poder diferenciar los pacientes que sobrevivirán ni la situación neurológica alcanzada 130 . La existencia de un patrón DTC de hiperemia (alta Vm en las arterias cerebrales medias (ACM), bajo IP y cociente inferior a 3 con la Vm registrada en el segmento distal submandibular de las arterias carótidas internas (ACI) ipsolaterales) se asocia de forma concluyente a un mal pronóstico neurológico con evolución a hipertensión intracraneal 131,132 . La presencia de un patrón DTC normal en esta primera valoración no implica en sí misma un buen pronóstico 133 .…”

Section: Evaluación Del Pronóstico Neurológico Del Síndrome Posparadaunclassified

Manejo del síndrome posparada cardíaca

et al. 2010

View full text Add to dashboard Cite

Since the advent of cardiopulmonary resuscitation more than 40 years ago, we have achieved a return to spontaneous circulation in a growing proportion of patients with cardiac arrest. Nevertheless, most of these patients die in the first few days after admission to the intensive care unit (ICU), and this situation has not improved over the years. Mortality in these patients is mainly associated to brain damage. Perhaps recognizing that cardiopulmonary resuscitation does not end with the return of spontaneous circulation but rather with the return of normal brain function and total stabilization of the patient would help improve the therapeutic management of these patients in the ICU. In this sense, the term cardiocerebral resuscitation proposed by some authors might be more appropriate. The International Liaison Committee on Resuscitation recently published a consensus document on the "Post-Cardiac Arrest Syndrome" and diverse authors have proposed that post-arrest care be integrated as the fifth link in the survival chain, after early warning, early cardiopulmonary resuscitation by witnesses, early defibrillation, and early advanced life support. The therapeutic management of patients that recover spontaneous circulation after cardiopulmonary resuscitation maneuvers based on life support measures and a series of improvised actions based on "clinical judgment" might not be the best way to treat patients with post-cardiac arrest syndrome. Recent studies indicate that using goal-guided protocols to manage these patients including therapeutic measures of proven efficacy, such as inducing mild therapeutic hypothermia and early revascularization, when indicated, can improve the prognosis considerably in these patients. Given that there is no current protocol based on universally accepted evidence, the Steering Committee of the National Cardiopulmonary Resuscitation Plan of the Spanish Society of Intensive Medicine and Cardiac Units has elaborated this document after a thorough review of the literature and an online discussion involving all the members of the committee and a consensus meeting with the aim of providing a platform for the development of local protocols in different ICSs in our country to fit their own means and characteristics.

show abstract

Section: Evaluación Del Pronóstico Neurológico Del Síndrome Posparadaunclassified

Manejo del síndrome posparada cardíaca

et al. 2010

View full text Add to dashboard Cite

show abstract

“…La presencia inicial de un patrón hiperdinámico vendría definida por altas Vm en las arterias cerebrales medias y bajos IP, con cocientes o3 con las Vm registradas en el segmento distal submandibular de las arterias carótidas internas ipsilaterales. Este patrón podría registrarse )normalmente* hasta transcurridos 30 min desde la RCE y reflejar reperfusión macroscópica hiperémica causada por el aumento de la PPC y el deterioro de la autorregulación cerebral; sin embargo, por encima de 30 min su presencia se asocia de forma concluyente a mal pronóstico neurológico con evolución a hipertensión intracraneal 42 , facilitado entre otras razones por un descenso relevante en la presión crítica de cierre vascular 43 .…”

Section: Hallazgos Inicialesunclassified

“…La presencia de un patrón de la DTC normal en esta primera valoración implica generalmente un buen pronóstico 42 . Sin embargo, debe considerarse siempre en estos casos el estado de la autorregulación cerebral, medida habitualmente como reserva hemodinámica cerebral o reactividad vascular cerebral (RVC).…”

Section: Hallazgos Inicialesunclassified

Utilidad del Doppler transcraneal en la resucitación de la parada cardíaca

et al. 2010

View full text Add to dashboard Cite

An effective tissue perfusion has decisive influence on the final prognosis both during cardiopulmonary resuscitation (CPR) and after recovery of spontaneous circulation (ROSC). The transcranial Doppler ultranosography (TCD) examines the velocity and pulsatility of cerebral blood flow, making it possible to perform "beat to beat" hemodynamic analysis. During CPR, TCD peak systolic velocity reflects cerebral perfusion of the chest compressions. Beyond 2 hours after ROSC, persistence in the cerebral arteries of a hemodynamic TCD pattern (low velocities with high pulsatilities) predicts poor neurological prognosis. Early or delayed presence of a hyperemic TCD pattern (high velocities with low pulsatilities) is associated conclusively with evolution to intracranial hypertension and its appearance during the rewarming process should lead to immediate return to therapeutic hypothermia. The coincidence of hypodynamic cerebral arteries and others with normal or hyperemic TCD patterns may indicate the presence of focal hypoperfusion that could predict stroke after ROSC.

show abstract

Cardiac Arrest

Crippa¹,

Taccone²

2020

Echography and Doppler of the Brain

View full text Add to dashboard Cite

Modificaciones en la velocidad de flujo cerebral medidas mediante Doppler transcraneal, tras maniobras de soporte vital avanzado

Cited by 5 publications

References 20 publications

Manejo del síndrome posparada cardíaca

Manejo del síndrome posparada cardíaca

Utilidad del Doppler transcraneal en la resucitación de la parada cardíaca

Cardiac Arrest

Contact Info

Product

Resources

About