Targeted high mean arterial pressure aggravates cerebral hemodynamics after extracorporeal resuscitation in swine

Abstract Background Extracorporeal cardiopulmonary resuscitation (E-CPR) is used for the treatment of refractory cardiac arrest. However, the optimal target to reach for mean arterial pressure (MAP) remains to be determined. We hypothesized that MAP levels critically modify cerebral hemodynamics dur...

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Autores principales:	Yael Levy, Alice Hutin, Fanny Lidouren, Nicolas Polge, Rocio Fernandez, Matthias Kohlhauer, Pierre-Louis Leger, Guillaume Debaty, Keith Lurie, Lionel Lamhaut, Bijan Ghaleh, Renaud Tissier
Formato:	article
Lenguaje:	EN
Publicado:	BMC 2021
Materias:	Cardiac arrest Resuscitation Extracorporeal circulation Epinephrine Blood pressure Medical emergencies. Critical care. Intensive care. First aid RC86-88.9
Acceso en línea:	https://doaj.org/article/d936f1556bb5419a8d0487a7a02e89c2
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spelling	oai:doaj.org-article:d936f1556bb5419a8d0487a7a02e89c22021-11-14T12:05:58ZTargeted high mean arterial pressure aggravates cerebral hemodynamics after extracorporeal resuscitation in swine10.1186/s13054-021-03783-31364-8535https://doaj.org/article/d936f1556bb5419a8d0487a7a02e89c22021-11-01T00:00:00Zhttps://doi.org/10.1186/s13054-021-03783-3https://doaj.org/toc/1364-8535Abstract Background Extracorporeal cardiopulmonary resuscitation (E-CPR) is used for the treatment of refractory cardiac arrest. However, the optimal target to reach for mean arterial pressure (MAP) remains to be determined. We hypothesized that MAP levels critically modify cerebral hemodynamics during E-CPR and tested two distinct targets (65–75 vs 80–90 mmHg) in a porcine model. Methods Pigs were submitted to 15 min of untreated ventricular fibrillation followed by 30 min of E-CPR. Defibrillations were then delivered until return of spontaneous circulation (ROSC). Extracorporeal circulation was initially set to an average flow of 40 ml/kg/min. The dose of epinephrine was set to reach a standard or a high MAP target level (65–75 vs 80–90 mmHg, respectively). Animals were followed during 120-min after ROSC. Results Six animals were included in both groups. During E-CPR, high MAP improved carotid blood flow as compared to standard MAP. After ROSC, this was conversely decreased in high versus standard MAP, while intra-cranial pressure was superior. The pressure reactivity index (PRx), which is the correlation coefficient between arterial blood pressure and intracranial pressure, also demonstrated inverted patterns of alteration according to MAP levels during E-CPR and after ROSC. In standard-MAP, PRx was transiently positive during E-CPR before returning to negative values after ROSC, demonstrating a reversible alteration of cerebral autoregulation during E-CPR. In high-MAP, PRx was negative during E-CPR but became sustainably positive after ROSC, demonstrating a prolonged alteration in cerebral autoregulation after ROSC. It was associated with a significant decrease in cerebral oxygen consumption in high- versus standard-MAP after ROSC. Conclusions During early E-CPR, MAP target above 80 mmHg is associated with higher carotid blood flow and improved cerebral autoregulation. This pattern is inverted after ROSC with a better hemodynamic status with standard versus high-MAP.Yael LevyAlice HutinFanny LidourenNicolas PolgeRocio FernandezMatthias KohlhauerPierre-Louis LegerGuillaume DebatyKeith LurieLionel LamhautBijan GhalehRenaud TissierBMCarticleCardiac arrestResuscitationExtracorporeal circulationEpinephrineBlood pressureMedical emergencies. Critical care. Intensive care. First aidRC86-88.9ENCritical Care, Vol 25, Iss 1, Pp 1-9 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Cardiac arrest Resuscitation Extracorporeal circulation Epinephrine Blood pressure Medical emergencies. Critical care. Intensive care. First aid RC86-88.9
spellingShingle	Cardiac arrest Resuscitation Extracorporeal circulation Epinephrine Blood pressure Medical emergencies. Critical care. Intensive care. First aid RC86-88.9 Yael Levy Alice Hutin Fanny Lidouren Nicolas Polge Rocio Fernandez Matthias Kohlhauer Pierre-Louis Leger Guillaume Debaty Keith Lurie Lionel Lamhaut Bijan Ghaleh Renaud Tissier Targeted high mean arterial pressure aggravates cerebral hemodynamics after extracorporeal resuscitation in swine
description	Abstract Background Extracorporeal cardiopulmonary resuscitation (E-CPR) is used for the treatment of refractory cardiac arrest. However, the optimal target to reach for mean arterial pressure (MAP) remains to be determined. We hypothesized that MAP levels critically modify cerebral hemodynamics during E-CPR and tested two distinct targets (65–75 vs 80–90 mmHg) in a porcine model. Methods Pigs were submitted to 15 min of untreated ventricular fibrillation followed by 30 min of E-CPR. Defibrillations were then delivered until return of spontaneous circulation (ROSC). Extracorporeal circulation was initially set to an average flow of 40 ml/kg/min. The dose of epinephrine was set to reach a standard or a high MAP target level (65–75 vs 80–90 mmHg, respectively). Animals were followed during 120-min after ROSC. Results Six animals were included in both groups. During E-CPR, high MAP improved carotid blood flow as compared to standard MAP. After ROSC, this was conversely decreased in high versus standard MAP, while intra-cranial pressure was superior. The pressure reactivity index (PRx), which is the correlation coefficient between arterial blood pressure and intracranial pressure, also demonstrated inverted patterns of alteration according to MAP levels during E-CPR and after ROSC. In standard-MAP, PRx was transiently positive during E-CPR before returning to negative values after ROSC, demonstrating a reversible alteration of cerebral autoregulation during E-CPR. In high-MAP, PRx was negative during E-CPR but became sustainably positive after ROSC, demonstrating a prolonged alteration in cerebral autoregulation after ROSC. It was associated with a significant decrease in cerebral oxygen consumption in high- versus standard-MAP after ROSC. Conclusions During early E-CPR, MAP target above 80 mmHg is associated with higher carotid blood flow and improved cerebral autoregulation. This pattern is inverted after ROSC with a better hemodynamic status with standard versus high-MAP.
format	article
author	Yael Levy Alice Hutin Fanny Lidouren Nicolas Polge Rocio Fernandez Matthias Kohlhauer Pierre-Louis Leger Guillaume Debaty Keith Lurie Lionel Lamhaut Bijan Ghaleh Renaud Tissier
author_facet	Yael Levy Alice Hutin Fanny Lidouren Nicolas Polge Rocio Fernandez Matthias Kohlhauer Pierre-Louis Leger Guillaume Debaty Keith Lurie Lionel Lamhaut Bijan Ghaleh Renaud Tissier
author_sort	Yael Levy
title	Targeted high mean arterial pressure aggravates cerebral hemodynamics after extracorporeal resuscitation in swine
title_short	Targeted high mean arterial pressure aggravates cerebral hemodynamics after extracorporeal resuscitation in swine
title_full	Targeted high mean arterial pressure aggravates cerebral hemodynamics after extracorporeal resuscitation in swine
title_fullStr	Targeted high mean arterial pressure aggravates cerebral hemodynamics after extracorporeal resuscitation in swine
title_full_unstemmed	Targeted high mean arterial pressure aggravates cerebral hemodynamics after extracorporeal resuscitation in swine
title_sort	targeted high mean arterial pressure aggravates cerebral hemodynamics after extracorporeal resuscitation in swine
publisher	BMC
publishDate	2021
url	https://doaj.org/article/d936f1556bb5419a8d0487a7a02e89c2
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Targeted high mean arterial pressure aggravates cerebral hemodynamics after extracorporeal resuscitation in swine

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