Using the relationship between brain tissue regional saturation of oxygen and mean arterial pressure to determine the optimal mean arterial pressure in patients following cardiac arrest: A pilot proof-of-concept study

Introduction: Prospectively assess cerebral autoregulation and optimal mean arterial pressure (MAP(OPT)) using the dynamic relationship between MAP and regional saturation of oxygen (rSO(2)) using near infrared spectroscopy. Methods: Feasibility study of twenty patients admitted to the intensive care unit following a cardiac arrest. All patients underwent continuous rSO(2) monitoring using the INVOS (R) cerebral oximeter. ICM+ brain monitoring software calculates the cerebral oximetry index (Cox) in real-time which is a moving Pearson correlation coefficient between 30 consecutive, 10-s averaged values of MAP and correspond rSO(2) signals. When rSO(2) increases with increasing MAP (COx >= 0.3), cerebral autoregulation is dysfunctional. Conversely, when rSO(2) remains constant or decreases with increasing MAP (Cox < 0.3), autoregulation is preserved. ICM+(R) fits a U-shaped curve through the COx values plotted vs. MAP. The MAP(OPT) is nadir of this curve. Results: The median age was 59 years (IQR 54-67) and 7 of 20 were female. The cardiac arrest was caused by myocardial infarction in 12 (60%) patients. Nineteen arrests were witnessed and return of spontaneous circulation occurred in a median of 15.5 min (IQR 8-33). Patients underwent a median of 30 h (IQR 23-46) of monitoring. COx curves and MAP(OPT) were generated in all patients. The mean overall MAP and MAP(OPT) were 76 mmHg (SD 10) and 76 mmHg (SD 7), respectively. MAP was outside of 5 mmHg from MAP(OPT) in 50% (SD 15) of the time. Out of the 7672 5-min averaged COx measurements, 1182 (15%) were at 0.3 or above, indicating absence of autoregulation. Multivariable polynomial fractional regression demonstrated an increase in COx with increasing temperature (A = 0.008). Conclusions: We demonstrated the feasibility to determine a MAP(OPT) using cerebral oximetry in patients after cardiac arrest. (C) 2016 Elsevier Ireland Ltd. All rights reserved.