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Title: | Early goal-directed haemodynamic optimization of cerebral oxygenation in comatose survivors after cardiac arrest: the Neuroprotect post-cardiac arrest trial | Authors: | AMELOOT, Koen DE DEYNE, Cathy EERTMANS, Ward Ferdinande, Bert DUPONT, Matthias Palmers, Pieter-Jan Petit, Tibaut Nuyens, Philippe MAEREMANS, Joren Vundelinckx, Joris Vanhaverbeke, Maarten Belmans, Ann Peeters, Ronald Demaerel, Philippe Lemmens, Robin DENS, Jo Janssens, Stefan |
Issue Date: | 2019 | Publisher: | OXFORD UNIV PRESS | Source: | EUROPEAN HEART JOURNAL, 40(22), p. 1804-1814 | Abstract: | Aims During the first 6-12 h of intensive care unit (ICU) stay, post-cardiac arrest (CA) patients treated with a mean arterial pressure (MAP) 65 mmHg target experience a drop of the cerebral oxygenation that may cause additional cerebral damage. Therefore, we investigated whether an early goal directed haemodynamic optimization strategy (EGDHO) (MAP 85-100 mmHg, SVO2 65-75%) is safe and could improve cerebral oxygenation, reduce anoxic brain damage, and improve outcome when compared with a MAP 65 mmHg strategy. Methods and results A total of 112 out-of-hospital CA patients were randomly assigned to EGDHO or MAP 65 mmHg strategies during the first 36 h of ICU stay. The primary outcome was the extent of anoxic brain damage as quantified by the percentage of voxels below an apparent diffusion coefficient (ADC) score of 650.10(-6) mm(2)/s on diffusion weighted magnetic resonance imaging (at day 5 +/- 2 post-CA). Main secondary outcome was favourable neurological outcome (CPC score 1-2) at 180 days. In patients assigned to EGDHO, MAP (P < 0.001), and cerebral oxygenation during the first 12 h of ICU stay (P = 0.04) were higher. However, the percentage of voxels below an ADC score of 650.10(-6) mm(2)/s did not differ between both groups [16% vs. 12%, odds ratio 1.37, 95% confidence interval (CI) 0.95-0.98; P = 0.09]. Also, the number of patients with favourable neurological outcome at 180 days was similar (40% vs. 38%, odds ratio 0.98, 95% CI 0.41-2.33; P = 0.96). The number of serious adverse events was lower in patients assigned to EGDHO (P = 0.02). Conclusion Targeting a higher MAP in post-CA patients was safe and improved cerebral oxygenation but did not improve the extent of anoxic brain damage or neurological outcome. | Notes: | [Ameloot, Koen; Ferdinande, Bert; Dupont, Matthias; Palmers, Pieter-Jan; Petit, Tibaut; Nuyens, Philippe; Maeremans, Joren; Dens, Jo] Ziekenhuis Oost Limburg, Dept Cardiol, Schiepse Bos 6, B-3600 Genk, Belgium. [Ameloot, Koen; Petit, Tibaut; Nuyens, Philippe; Vanhaverbeke, Maarten; Belmans, Ann; Janssens, Stefan] Univ Hosp Leuven, Dept Cardiol, Leuven, Belgium. [Ameloot, Koen; De Deyne, Cathy; Eertmans, Ward; Maeremans, Joren; Dens, Jo] Univ Hasselt, Fac Med & Life Sci, Diepenbeek, Belgium. [De Deyne, Cathy; Eertmans, Ward; Vundelinckx, Joris] Ziekenhuis Oost Limburg, Dept Anesthesiol & Crit Care Med, Genk, Belgium. [Peeters, Ronald; Demaerel, Philippe] Univ Hosp Leuven, Dept Neurol, Leuven, Belgium. [Lemmens, Robin] Univ Hosp Leuven, Dept Radiol, Leuven, Belgium. [Lemmens, Robin] VIB, Ctr Brain & Dis Res, Neurobiol Lab, Leuven, Belgium. [Lemmens, Robin] Univ Leuven, KU Leuven, Dept Neurosci, Expt Neurol, Leuven, Belgium. [Lemmens, Robin] Univ Leuven, KU Leuven, LBI, Leuven, Belgium. | Keywords: | Cardiac arrest; Haemodynamics;Cardiac arrest; Haemodynamics | Document URI: | http://hdl.handle.net/1942/29968 | ISSN: | 0195-668X | e-ISSN: | 1522-9645 | DOI: | 10.1093/eurheartj/ehz120 | ISI #: | 000490131200014 | Rights: | All rights reserved. VC The Author(s) 2019. For permissions, please email: journals.permissions@oup.com. | Category: | A1 | Type: | Journal Contribution | Validations: | ecoom 2020 |
Appears in Collections: | Research publications |
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