Modification of focal cerebral ischemia by cardiac output augmentation

Keller, Ted S.; McGillicuddy, John E.; LaBond, Virginia; Kindt, Glenn W.

doi:10.1016/0022-4804(85)90096-4

Cited by 45 publications

(19 citation statements)

References 22 publications

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“…In their study, Sinha et al found a strong correlation between the flow volume in the common carotid artery and the CO, and about 11 % of the CO was distributed to each common carotid artery. Other studies have also shown correlation between the carotid artery Doppler flow volume measurement and the CO [15,16].…”

Section: Discussionmentioning

confidence: 73%

Feasibility of common carotid artery point of care ultrasound in cardiac output measurements compared to invasive methods

et al. 2014

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Background Cardiac output (CO) measurement in the intensive care unit (ICU) requires invasive devices such as the pulmonary artery (PA) catheter or arterial waveform pulse contour analysis (PCA). This study tests the accuracy and feasibility of point of care ultrasound (POCUS) of the common carotid artery to estimate the CO non-invasively and compare it to existing invasive CO measurement modalities. Methods Patients admitted to the surgical and cardiothoracic ICU in a tertiary university-affiliated academic center during a 4-month period, with invasive hemodynamic monitoring devices for management, were included in this cohort study. Common carotid artery POCUS was performed to measure the CO and the results were compared to an invasive device. Results Intensivists and ICU fellows, using ultrasound of the common carotid artery, obtained the CO measurements. Images of the Doppler flow and volume were obtained at the level of the thyroid gland. Concurrent CO measured via invasive devices was recorded. The patient cohort comprised 36 patients; 52 % were females. The average age was 59 ± 13 years, and 66 % were monitored via PCA device and 33 % via PA catheter. Intraclass correlation coefficient (ICC) analysis demonstrated almost perfect correlation (0.8152) between measurements of CO via ultrasound vs. invasive modalities. The ICC between PO-CUS and the invasive measurement via PCA was 0.84 and via PA catheter 0.74, showing substantial agreement between the ultrasound and both invasive modalities. Conclusions Common carotid artery POCUS offers a non-invasive method of measuring the CO in the critically ill population.Keywords Cardiac output Á Ultrasound Á Carotid doppler Á Pulmonary artery catheter Á Pulse contour analysis Á Point of care ultrasound Abstract Background La misurazione della gittata cardiaca (CO) in Unità di Terapia Intensiva (ICU) richiede dispositivi invasivi come il cateterismo dell'arteria polmonare (PA) o l'analisi dell'onda dell'impulso arterioso (PCA). Questo studio si propone di valutare l'accuratezza e la fattibilità dell'ecografia (POCUS) della carotide comune per stimare la CO in modo non invasivo e confrontarla con le modalità esistenti di misurazione della CO effettuate in maniera invasiva. Metodi I pazienti ricoverati in terapia intensiva chirurgica e cardiotoracica in un centro accademico, affiliato con l'università, nel corso di un periodo di quattro mesi, sottoposti a dispositivi di monitoraggio emodinamico invasivo sono stati inclusi in questo studio. E' stata eseguita l'ecografia dell'arteria carotide comune per misurare la CO ed i risultati sono stati confrontati con una tecnica invasiva. Risultati Medici di terapia intensiva e borsisti, utilizzando l'ecografia della carotide comune, hanno ottenuto le misurazioni della CO. Immagini del flusso Doppler e di volume sono state ottenute a livello della ghiandola tiroidea. Contemporaneamente è è stata registrata la CO mediante dispositivi invasivi. Il gruppo era costituito da 36 Ultrasound (2015) 18:127-133 DOI 10.1007 pazien...

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Section: Discussionmentioning

confidence: 73%

Feasibility of common carotid artery point of care ultrasound in cardiac output measurements compared to invasive methods

et al. 2014

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“…Data in the literature on the correlation of cardiac output and CBF in these patients are controversial. Some authors described a passive association between HMV and CBF in primates 6,21 ; others failed to show a correlation in humans. 7 The disappointing results of an Austrian hemodilution stroke trial 22 should be discussed in this context.…”

Section: Discussionmentioning

confidence: 99%

Lack of association between carotid artery volume blood flow and cardiac output.

Eicke

Schlichting²,

Mohr-Ahaly³

et al. 2001

J of Ultrasound Medicine

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Objective. The correlation of cardiac output and cerebral perfusion is unclear. We tested this potential association by correlating cardiac output data obtained by echocardiography and cerebral blood flow data as determined by color M-mode measurements of carotid artery blood flow. Methods. We studied 43 patients with a broad spectrum of cardiac performance by means of transthoracic echocardiography. In these patients, different cardiac indices such as stroke volume, ejection fraction, and heart minute volume were determined. The data were correlated with volumetric flow measurements (color M-mode duplex system) of the common carotid arteries bilaterally. Results. Heart minute volume ranged from 1.632 to 9.836 mL/min (mean ± SD, 4.652 ± 1.621 mL/min); ejection fraction ranged from 18% to 76% (mean, 48% ± 16%). The relative fraction of carotid volume flow compared with heart minute volume was 15% ± 6%. There was no correlation between ejection fraction, stroke volume, or heart minute volume and absolute volume flow in the carotid arteries when being adjusted for age. There was a highly significant inverse correlation (r = -0.8; P < .0001) of the relative fraction of the carotid volume flow (carotid volume flow/heart minute volume [percent]) and the heart minute volume. Conclusion. Our data support the concept that cerebral blood flow is independent of cardiac output. Key words: cardiac output; cerebrovascular circulation; ultrasonography.Received January 18, 2001, from the Departments of Neurology (B.M.E., J.v.S., H.C.H.) and Cardiology (S.M.-K., A.S., R.S.v.B.) Abbreviations ASV, absolute stroke volume; BS, body surface; CBF, cerebral blood flow; CCA, common carotid artery; CI, cardiac index; EDV, end-diastolic volume; EF, ejection fraction; ESV, end-systolic volume; HMV, heart minute volume; HR, heart rate; LV, left ventricular; RSV, relative stroke volume; SPECT, single-photon emission computed tomography; Vol, volume erebral autoregulation maintains constant brain perfusion over a wide blood pressure range between 60 and 150 mm Hg. 1 Within these limits, cerebral blood flow (CBF) is not directly correlated with cerebral perfusion pressure. 2 A review of the literature suggests that the impact of cardiac output on CBF is uncertain, with conflicting data in animals, healthy volunteers, and neurosurgical or cardiologic patients. [3][4][5][6][7][8] In addition, methodological differences to define CBF enhance difficulties with interpreting these studies. Cerebral blood flow was assessed by means of singlephoton emission computed tomography (SPECT) 3,6,7 or blood flow velocity of the middle cerebral artery. 9 These methods are difficult, because they either require radioactive tracers (SPECT) or reflect only flow velocity (transcranial Doppler ultrasonography) rather than flow volume data. Clinical trials comparing xenon Xe 133 SPECT and transcranial Doppler data revealed conflict-

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“…Originally, patients were treated with a combination of hypervolemia, hemodilution, and induced hypertension ("triple-H therapy") to augment cerebral blood flow by increasing cerebral perfusion pressure and lowering blood viscosity [36][37][38]. However, as the various components of triple-H therapy were studied, the focus of therapy has shifted to euvolemic-induced hypertension.…”

Section: Hemodynamic Augmentationmentioning

confidence: 99%