The Utility of a Point-of-Care Transcranial Doppler Ultrasound Management Algorithm on Outcomes in Pediatric Asphyxial Out-of-Hospital Cardiac Arrest – An Exploratory Investigation

Abstract

BackgroundTranscranial Doppler ultrasound is a sensitive, real time tool used for monitoring cerebral blood flow; it could provide additional information for cerebral perfusion in cerebral resuscitation during post cardiac arrest care. The aim of the current study was to evaluate the utility of a point-of-care transcranial Doppler ultrasound management algorithm on outcomes in pediatric asphyxial out-of-hospital cardiac arrest.MethodsThis retrospective cohort study was conducted in two tertiary pediatric intensive care units between January 2013 and June 2018. All children between 1 month and 18 years of age with asphyxial out-of-hospital cardiac arrest and a history of at least 3 min of chest compressions, who were treated with therapeutic hypothermia and survived for 12 h or more after the return of circulation were eligible for inclusion.ResultsTwenty-one patients met the eligibility criteria for the study. Sixteen (76.2%) of the 21 children were male, and the mean age was 2.8 ± 4.1 years. Seven (33.3%) of the children had underlying disorders. The overall 1-month survival rate was 52.4%. Twelve (57.1%) of the children received point-of-care transcranial Doppler ultrasound. The 1-month survival rate was significantly higher (p = 0.03) in the point-of-care transcranial Doppler ultrasound group (9/12, 75%) than in the non-point-of-care transcranial Doppler ultrasound group (2/9, 22.2%).ConclusionsPoint-of-care transcranial Doppler ultrasound group was associated with a significantly better 1-month survival rate compared with no point-of-care transcranial Doppler ultrasound group in pediatric asphyxial out-of-hospital cardiac arrest.

Update in Pediatric Neurocritical Care: What a Neurologist Caring for Critically Ill Children Needs to Know

“…It may also help monitor the impact and safety of ICU therapies (e.g., monitoring for reduced CBF during hyperventilation for ICP therapy), and monitor patients during extracorporeal membrane oxygenation (ECMO). 171,[228][229][230] TCD goal-directed therapy has been described, [231][232][233][234] but larger prospective studies are needed to assess its clinical impact. Importantly, trending TCD exams over time and proper integration into the patient's clinical context is essential.…”

Transcranial Doppler Ultrasound, a Review for the Pediatric Intensivist

“…No patient with a favorable neurologic outcome had abnormal CBFV on day 1, yet 38% of those in the unfavorable outcome group had abnormal CBFV ( p = 0.03). A recent pilot study of 21 pediatric survivors of asphyxial out-of-hospital cardiac arrest who underwent therapeutic hypothermia used point-of-care TCD to guide therapy [ 17 ]. TCDs were categorized into three groups: (1) continuous waveform with a PI < 1.1 and a normal or high Vm, (2) continuous waveform with PI between 1.1–2 with low or normal Vm, and (3) discontinuous waveform or continuous waveform with PI > 2.0 and low Vm.…”