Different Stratification of Physiological Factors Affecting Cerebral Perfusion Pressure in Hypoxic-Ischemic Brain Injury after Cardiac Arrest According to Visible or Non-Visible Primary Brain Injury: A Retrospective Observational Study

We aimed to explore the stratification of physiological factors affecting cerebral perfusion pressure, including arterial oxygen tension, arterial carbon dioxide tension, mean arterial pressure, intracranial pressure (ICP), and blood-brain barrier (BBB) status, with respect to primary or secondary b...

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Autores principales:	Changshin Kang, Wonjoon Jeong, Jung Soo Park, Yeonho You, Jin Hong Min, Yong Chul Cho, Hong Joon Ahn, Yong Nam In, In Ho Lee
Formato:	article
Lenguaje:	EN
Publicado:	MDPI AG 2021
Materias:	out-of-hospital cardiac arrest hypoxic-ischemic brain injury targeted temperature management primary brain injury secondary brain injury Medicine R
Acceso en línea:	https://doaj.org/article/37fb1d5fbe99433e96cf5d391035614c
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spelling	oai:doaj.org-article:37fb1d5fbe99433e96cf5d391035614c2021-11-25T18:02:18ZDifferent Stratification of Physiological Factors Affecting Cerebral Perfusion Pressure in Hypoxic-Ischemic Brain Injury after Cardiac Arrest According to Visible or Non-Visible Primary Brain Injury: A Retrospective Observational Study10.3390/jcm102253852077-0383https://doaj.org/article/37fb1d5fbe99433e96cf5d391035614c2021-11-01T00:00:00Zhttps://www.mdpi.com/2077-0383/10/22/5385https://doaj.org/toc/2077-0383We aimed to explore the stratification of physiological factors affecting cerebral perfusion pressure, including arterial oxygen tension, arterial carbon dioxide tension, mean arterial pressure, intracranial pressure (ICP), and blood-brain barrier (BBB) status, with respect to primary or secondary brain injury (PBI or SBI) after out-of-hospital cardiac arrest (OHCA). Among the retrospectively enrolled 97 comatose OHCA survivors undergoing post-cardiac arrest (PCA) care, 46 (47.4%) with already established PBI (high signal intensity (HSI) on diffusion-weighted imaging (DWI) had higher ICP (<i>p</i> = 0.02) and poorer BBB status (<i>p</i> < 0.01) than the non-HSI group. On subgroup analysis within the non-HSI group to exclude the confounding effect of already established PBI, 40 (78.4%) patients with good neurological outcomes had lower ICP at 24 h (11.0 vs. 16.0 mmHg, <i>p</i> < 0.01) and more stable BBB status (<i>p</i> = 0.17 in pairwise comparison) compared to those with poor neurological outcomes, despite the non-significant differences in other physiological factors. OHCA survivors with HSI on DWI showed significantly higher ICP and poorer BBB status at baseline before PCA care than those without HSI. Despite the negative DWI findings before PCA care, OHCA survivors have a cerebral penumbra at risk for potentially leading the poor neurological outcome from unsuppressed SBI, which may be associated with increased ICP and BBB permeability.Changshin KangWonjoon JeongJung Soo ParkYeonho YouJin Hong MinYong Chul ChoHong Joon AhnYong Nam InIn Ho LeeMDPI AGarticleout-of-hospital cardiac arresthypoxic-ischemic brain injurytargeted temperature managementprimary brain injurysecondary brain injuryMedicineRENJournal of Clinical Medicine, Vol 10, Iss 5385, p 5385 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	out-of-hospital cardiac arrest hypoxic-ischemic brain injury targeted temperature management primary brain injury secondary brain injury Medicine R
spellingShingle	out-of-hospital cardiac arrest hypoxic-ischemic brain injury targeted temperature management primary brain injury secondary brain injury Medicine R Changshin Kang Wonjoon Jeong Jung Soo Park Yeonho You Jin Hong Min Yong Chul Cho Hong Joon Ahn Yong Nam In In Ho Lee Different Stratification of Physiological Factors Affecting Cerebral Perfusion Pressure in Hypoxic-Ischemic Brain Injury after Cardiac Arrest According to Visible or Non-Visible Primary Brain Injury: A Retrospective Observational Study
description	We aimed to explore the stratification of physiological factors affecting cerebral perfusion pressure, including arterial oxygen tension, arterial carbon dioxide tension, mean arterial pressure, intracranial pressure (ICP), and blood-brain barrier (BBB) status, with respect to primary or secondary brain injury (PBI or SBI) after out-of-hospital cardiac arrest (OHCA). Among the retrospectively enrolled 97 comatose OHCA survivors undergoing post-cardiac arrest (PCA) care, 46 (47.4%) with already established PBI (high signal intensity (HSI) on diffusion-weighted imaging (DWI) had higher ICP (<i>p</i> = 0.02) and poorer BBB status (<i>p</i> < 0.01) than the non-HSI group. On subgroup analysis within the non-HSI group to exclude the confounding effect of already established PBI, 40 (78.4%) patients with good neurological outcomes had lower ICP at 24 h (11.0 vs. 16.0 mmHg, <i>p</i> < 0.01) and more stable BBB status (<i>p</i> = 0.17 in pairwise comparison) compared to those with poor neurological outcomes, despite the non-significant differences in other physiological factors. OHCA survivors with HSI on DWI showed significantly higher ICP and poorer BBB status at baseline before PCA care than those without HSI. Despite the negative DWI findings before PCA care, OHCA survivors have a cerebral penumbra at risk for potentially leading the poor neurological outcome from unsuppressed SBI, which may be associated with increased ICP and BBB permeability.
format	article
author	Changshin Kang Wonjoon Jeong Jung Soo Park Yeonho You Jin Hong Min Yong Chul Cho Hong Joon Ahn Yong Nam In In Ho Lee
author_facet	Changshin Kang Wonjoon Jeong Jung Soo Park Yeonho You Jin Hong Min Yong Chul Cho Hong Joon Ahn Yong Nam In In Ho Lee
author_sort	Changshin Kang
title	Different Stratification of Physiological Factors Affecting Cerebral Perfusion Pressure in Hypoxic-Ischemic Brain Injury after Cardiac Arrest According to Visible or Non-Visible Primary Brain Injury: A Retrospective Observational Study
title_short	Different Stratification of Physiological Factors Affecting Cerebral Perfusion Pressure in Hypoxic-Ischemic Brain Injury after Cardiac Arrest According to Visible or Non-Visible Primary Brain Injury: A Retrospective Observational Study
title_full	Different Stratification of Physiological Factors Affecting Cerebral Perfusion Pressure in Hypoxic-Ischemic Brain Injury after Cardiac Arrest According to Visible or Non-Visible Primary Brain Injury: A Retrospective Observational Study
title_fullStr	Different Stratification of Physiological Factors Affecting Cerebral Perfusion Pressure in Hypoxic-Ischemic Brain Injury after Cardiac Arrest According to Visible or Non-Visible Primary Brain Injury: A Retrospective Observational Study
title_full_unstemmed	Different Stratification of Physiological Factors Affecting Cerebral Perfusion Pressure in Hypoxic-Ischemic Brain Injury after Cardiac Arrest According to Visible or Non-Visible Primary Brain Injury: A Retrospective Observational Study
title_sort	different stratification of physiological factors affecting cerebral perfusion pressure in hypoxic-ischemic brain injury after cardiac arrest according to visible or non-visible primary brain injury: a retrospective observational study
publisher	MDPI AG
publishDate	2021
url	https://doaj.org/article/37fb1d5fbe99433e96cf5d391035614c
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Different Stratification of Physiological Factors Affecting Cerebral Perfusion Pressure in Hypoxic-Ischemic Brain Injury after Cardiac Arrest According to Visible or Non-Visible Primary Brain Injury: A Retrospective Observational Study

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