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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 
Ferdinande, Bert
DUPONT, Matthias 
Palmers, Pieter-Jan
Petit, Tibaut
Nuyens, Philippe
Vundelinckx, Joris
Vanhaverbeke, Maarten
Belmans, Ann
Peeters, Ronald
Demaerel, Philippe
Lemmens, Robin
Janssens, Stefan
Issue Date: 2019
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
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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:
Category: A1
Type: Journal Contribution
Validations: ecoom 2020
Appears in Collections:Research publications

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