Influence of α-Stat and pH-Stat blood gas management strategies on cerebral blood flow and oxygenation in patients treated with therapeutic hypothermia after out-of-hospital cardiac arrest: A crossover study

Critical Care Medicine

Volumn 42, Issue 8, 2014, Pages 1849-1861

  Voicu, Sebastian ^a,b   Deye, Nicolas ^a,b   Malissin, Isabelle ^a   Vigué, Bernard ^c   Brun, Pierre Yves ^a   Haik, William ^a   Champion, Sebastien ^a   Megarbane, Bruno ^a,d   Sideris, Georgios ^a,b   Mebazaa, Alexandre ^a,b   Carli, Pierre ^e   Manivet, Philippe ^a,b   Baud, Frédéric J ^a,d  

^a HÔPITAL LARIBOISIÈRE   (France)

^b University of Paris   (France)

^c BICÊTRE HOSPITAL   (France)

^d INSERM   (France)

^e HÔPITAL NECKER ENFANTS MALADES   (France)

Author keywords

blood gases; carbon dioxide; cardiac arrest; cerebral blood flow; cerebral oxygen extraction; therapeutic hypothermia

Indexed keywords

ADRENALIN; CATECHOLAMINE; DOBUTAMINE; GLUCOSE; LACTIC ACID; NORADRENALIN; SODIUM;

ACUTE HEART INFARCTION; ADULT; ALPHA STAT; ARTERIAL CARBON DIOXIDE TENSION; ARTERIAL OXYGEN SATURATION; ARTERIAL PH; ARTERIAL PRESSURE; ARTICLE; BLOOD FLOW VELOCITY; BLOOD GAS ANALYSIS; BODY TEMPERATURE; BRAIN BLOOD FLOW; BRAIN METABOLISM; BRAIN PERFUSION; BREATHING RATE; CEREBRAL OXYGENATION; CLINICAL ARTICLE; COLLAPSE; CONTROLLED STUDY; CORE TEMPERATURE; DIABETES MELLITUS; EXTRACTION; FEMALE; GLUCOSE BLOOD LEVEL; HEART RATE; HEART VENTRICLE FIBRILLATION; HUMAN; HYPERCHOLESTEROLEMIA; HYPERTENSION; HYPOXEMIA; INDUCED HYPOTHERMIA; INFUSION RATE; INTENSIVE CARE UNIT; ISCHEMIC HEART DISEASE; JUGULAR VEIN; LACTATE BLOOD LEVEL; LUNG MINUTE VOLUME; MALE; MEDICAL HISTORY; MIDDLE CEREBRAL ARTERY; OBSERVATIONAL STUDY; OUT OF HOSPITAL CARDIAC ARREST; OXYGEN SATURATION; PH STAT; POSITIVE END EXPIRATORY PRESSURE; PRIORITY JOURNAL; PROSPECTIVE STUDY; RESUSCITATION; RETURN OF SPONTANEOUS CIRCULATION; SMOKING; SODIUM BLOOD LEVEL; SURVIVOR; TIDAL VOLUME; BRAIN; BRAIN CIRCULATION; COMPARATIVE STUDY; CROSSOVER PROCEDURE; MIDDLE AGED; OUT-OF-HOSPITAL CARDIAC ARREST; OXYGEN CONSUMPTION; PATHOPHYSIOLOGY; PH; PROCEDURES; VASCULARIZATION;

BLOOD FLOW VELOCITY; BLOOD GAS ANALYSIS; BRAIN; CEREBROVASCULAR CIRCULATION; CROSS-OVER STUDIES; FEMALE; HUMANS; HYDROGEN-ION CONCENTRATION; HYPOTHERMIA, INDUCED; INTENSIVE CARE UNITS; JUGULAR VEINS; MALE; MIDDLE AGED; OUT-OF-HOSPITAL CARDIAC ARREST; OXYGEN CONSUMPTION; PROSPECTIVE STUDIES;

EID: 84904728966     PISSN: 00903493     EISSN: 15300293     Source Type: Journal    
DOI: 10.1097/CCM.0000000000000339     Document Type: Article

References (46)

1. Morrison LJ, Deakin CD, Morley PT, et al; Advanced Life Support Chapter Collaborators: Part 8: Advanced life support: 2010 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. Circulation 2010; 122:S345-S421
2. Curley G, Laffey JG, Kavanagh BP: Bench-to-bedside review: Carbon dioxide. Crit Care 2010; 14:220
3. Laffey JG, Kavanagh BP: Hypocapnia. N Engl J Med 2002; 347:43-53
4. Roberts BW, Kilgannon JH, Chansky ME, et al: Association between postresuscitation partial pressure of arterial carbon dioxide and neurological outcome in patients with post-cardiac arrest syndrome. Circulation 2013; 127:2107-2113
5. Schneider AG, Eastwood GM, Bellomo R, et al: Arterial carbon dioxide tension and outcome in patients admitted to the intensive care unit after cardiac arrest. Resuscitation 2013; 84:927-934
6. Sunde K, Pytte M, Jacobsen D, et al: Implementation of a standardised treatment protocol for post resuscitation care after out-of-hospital cardiac arrest. Resuscitation 2007; 73:29-39
7. Falkenbach P, Kämäräinen A, Mäkelä A, et al: Incidence of iatrogenic dyscarbia during mild therapeutic hypothermia after successful resuscitation from out-of-hospital cardiac arrest. Resuscitation 2009; 80:990-993
8. Polderman KH: Mechanisms of action, physiological effects, and complications of hypothermia. Crit Care Med 2009; 37:S186-S202
9. Hoover LR, Dinavahi R, Cheng WP, et al: Jugular venous oxygenation during hypothermic cardiopulmonary bypass in patients at risk for abnormal cerebral autoregulation: Infuence of alpha-Stat versus pH-stat blood gas management. Anesth Analg 2009; 108:1389-1393
10. Bisschops LL, Hoedemaekers CW, Simons KS, et al: Preserved metabolic coupling and cerebrovascular reactivity during mild hypothermia after cardiac arrest. Crit Care Med 2010; 38:1542-1547
11. Pynnönen L, Falkenbach P, Kämäräinen A, et al: Therapeutic hypothermia after cardiac arrest-Cerebral perfusion and metabolism during upper and lower threshold normocapnia. Resuscitation 2011; 82:1174-1179
12. Bernard SA, Gray TW, Buist MD, et al: Treatment of comatose survivors of out-of-hospital cardiac arrest with induced hypothermia. N Engl J Med 2002; 346:557-563
13. Hypothermia after Cardiac Arrest Study Group: Mild therapeutic hypothermia to improve the neurologic outcome after cardiac arrest. N Engl J Med 2002; 346:549-556
14. Duebener LF, Hagino I, Sakamoto T, et al: Effects of pH management during deep hypothermic bypass on cerebral microcirculation: Alpha-stat versus pH-stat. Circulation 2002; 106:I103-I108
15. Pokela M, Dahlbacka S, Biancari F, et al: pH-stat versus alpha-stat perfusion strategy during experimental hypothermic circulatory arrest: A microdialysis study. Ann Thorac Surg 2003; 76:1215-1226
16. Priestley MA, Golden JA, O'Hara IB, et al: Comparison of neurologic outcome after deep hypothermic circulatory arrest with alpha-stat and pH-stat cardiopulmonary bypass in newborn pigs. J Thorac Cardiovasc Surg 2001; 121:336-343
17. Kiziltan HT, Baltali M, Bilen A, et al: Comparison of alpha-stat and pH-stat cardiopulmonary bypass in relation to jugular venous oxygen saturation and cerebral glucose-oxygen utilization. Anesth Analg 2003; 96:644-650, table of contents
18. Nauphal M, El-Khatib M, Taha S, et al: Effect of alpha-stat vs. pH-stat strategies on cerebral oximetry during moderate hypothermic cardiopulmonary bypass. Eur J Anaesthesiol 2007; 24:15-19
19. Gopinath SP, Robertson CS, Contant CF, et al: Jugular venous desat-uration and outcome after head injury. J Neurol Neurosurg Psychiatry 1994; 57:717-723
20. Abdul Aziz KA, Meduoye A: Is pH-stat or alpha-stat the best technique to follow in patients undergoing deep hypothermic circulatory arrest? Interact Cardiovasc Thorac Surg 2010; 10:271-282
21. 2 in patients with traumatic brain injury. Intensive Care Med 2000; 26:722-728
22. Kollmar R, Georgiadis D, Schwab S: Alpha-stat versus pH-stat guided ventilation in patients with large ischemic stroke treated by hypothermia. Neurocrit Care 2009; 10:173-180
23. Jacobs I, Nadkarni V, Bahr J, et al: Cardiac arrest and cardiopulmonary resuscitation outcome reports: Update and simplification of the Utstein templates for resuscitation registries: A statement for healthcare professionals from a task force of the International Liaison Committee on Resuscitation (American Heart Association, European Resuscitation Council, Australian Resuscitation Council, New Zealand Resuscitation Council, Heart and Stroke Foundation of Canada, InterAmerican Heart Foundation, Resuscitation Councils of Southern Africa). Circulation 2004; 110:3385-3397
24. Sideris G, Voicu S, Dillinger JG, et al: Value of post-resuscitation electrocardiogram in the diagnosis of acute myocardial infarction in out-of-hospital cardiac arrest patients. Resuscitation 2011; 82:1148-1153
25. Deakin CD, Morrison LJ, Morley PT, et al; Advanced Life Support Chapter Collaborators: Part 8: Advanced life support: 2010 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations. Resuscitation 2010; 81(Suppl 1):e93-e174
26. Chamorro C, Borrallo JM, Romera MA, et al: Anesthesia and analgesia protocol during therapeutic hypothermia after cardiac arrest: A systematic review. Anesth Analg 2010; 110:1328-1335
27. Klingelhöfer J, Sander D: Doppler CO2 test as an indicator of cerebral vasoreactivity and prognosis in severe intracranial hemorrhages. Stroke 1992; 23:962-966
28. Aaslid R, Markwalder TM, Nornes H: Noninvasive transcranial Doppler ultrasound recording of fow velocity in basal cerebral arteries. J Neurosurg 1982; 57:769-774
29. Martí-Fàbregas J, Belvís R, Guardia E, et al: Prognostic value of pul-satility index in acute intracerebral hemorrhage. Neurology 2003; 61:1051-1056
30. Millar SA, Alston RP, Souter MJ, et al: Aerobic, anaerobic and combination estimates of cerebral hypoperfusion during and after cardiac surgery. Br J Anaesth 1999; 83:936-939
31. Lemiale V, Huet O, Vigué B, et al: Changes in cerebral blood fow and oxygen extraction during post-resuscitation syndrome. Resuscitation 2008; 76:17-24
32. Jennett B, Bond M: Assessment of outcome after severe brain damage. Lancet 1975; 1:480-484
33. Krejza J, Mariak Z, Walecki J, et al: Transcranial color Doppler sonography of basal cerebral arteries in 182 healthy subjects: Age and sex variability and normal reference values for blood fow parameters. AJR Am J Roentgenol 1999; 172:213-218
34. Sorteberg W, Langmoen IA, Lindegaard KF, et al: Side-to-side differences and day-to-day variations of transcranial Doppler parameters in normal subjects. J Ultrasound Med 1990; 9:403-409
35. Bisschops LL, van der Hoeven JG, Hoedemaekers CW: Effects of prolonged mild hypothermia on cerebral blood fow after cardiac arrest. Crit Care Med 2012; 40:2362-2367
36. Buunk G, van der Hoeven JG, Meinders AE: Cerebrovascular reactivity in comatose patients resuscitated from a cardiac arrest. Stroke 1997; 28:1569-1573
37. Sundgreen C, Larsen FS, Herzog TM, et al: Autoregulation of cerebral blood fow in patients resuscitated from cardiac arrest. Stroke 2001; 32:128-132
38. Joshi B, Brady K, Lee J, et al: Impaired autoregulation of cerebral blood fow during rewarming from hypothermic cardiopulmonary bypass and its potential association with stroke. Anesth Analg 2010; 110:321-328
39. Wessels T, Harrer JU, Jacke C, et al: The prognostic value of early transcranial Doppler ultrasound following cardiopulmonary resuscitation. Ultrasound Med Biol 2006; 32:1845-1851
40. Macmillan CS, Andrews PJ, Easton VJ: Increased jugular bulb saturation is associated with poor outcome in traumatic brain injury. J Neurol Neurosurg Psychiatry 2001; 70:101-104
41. 2. Anesth Analg 1987; 66:825-832
42. Henriksen L, Hjelms E, Lindeburgh T: Brain hyperperfusion during cardiac operations. Cerebral blood fow measured in man by intra-arterial injection of xenon 133: Evidence suggestive of intraoperative microembolism. J Thorac Cardiovasc Surg 1983; 86:202-208
43. Laussen PC: Optimal blood gas management during deep hypother-mic paediatric cardiac surgery: Alpha-stat is easy, but pH-stat may be preferable. Paediatr Anaesth 2002; 12:199-204
44. Czosnyka M, Brady K, Reinhard M, et al: Monitoring of cerebrovas-cular autoregulation: Facts, myths, and missing links. Neurocrit Care 2009; 10:373-386
45. Bhatia A, Gupta AK: Neuromonitoring in the intensive care unit. I. Intracranial pressure and cerebral blood fow monitoring. Intensive Care Med 2007; 33:1263-1271
46. van Genderen ME, Lima A, Akkerhuis M, et al: Persistent peripheral and microcirculatory perfusion alterations after out-of-hospital cardiac arrest are associated with poor survival. Crit Care Med 2012; 40:2287-2294