Transcranial Doppler during the first week after cardiac arrest and association with 6-month outcomes

Antje Reichenbach; Lars Alteheld; Julia Henriksen; Espen Rostrup Nakstad; Geir Øystein Andersen; Kjetil Sunde; Jūratė Šaltytė Benth; Christofer Lundqvist

doi:10.3389/fneur.2023.1222401

Transcranial Doppler during the first week after cardiac arrest and association with 6-month outcomes

Front Neurol. 2023 Oct 4:14:1222401. doi: 10.3389/fneur.2023.1222401. eCollection 2023.

Authors

Antje Reichenbach¹, Lars Alteheld², Julia Henriksen², Espen Rostrup Nakstad^{3

4}, Geir Øystein Andersen⁵, Kjetil Sunde^{6

7}, Jūratė Šaltytė Benth^{8

9}, Christofer Lundqvist^{1

8

9}

Affiliations

¹ Department of Neurology, Akershus University Hospital, Lørenskog, Norway.
² Department of Neurology, Oslo University Hospital Ullevaal, Oslo, Norway.
³ Department of Acute Medicine, Oslo University Hospital Ullevaal, Oslo, Norway.
⁴ Norwegian National Unit for Chemical, Biological, Radioactive, Nuclear, and Explosive Medicine, Oslo University Hospital Ullevaal, Oslo, Norway.
⁵ Department of Cardiology, Oslo University Hospital Ullevaal, Oslo, Norway.
⁶ Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
⁷ Department of Anesthesia and Intensive Care Medicine, Oslo University Hospital Ullevaal, Oslo, Norway.
⁸ Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway.
⁹ Faculty of Medicine, Institute of Clinical Medicine, Campus Akershus University Hospital, University of Oslo, Oslo, Norway.

Abstract

Background: Early prediction of outcomes in comatose patients after out-of-hospital cardiac arrest is challenging. Prognostication tools include clinical examination, biomarkers, and neuroradiological and neurophysiological tests. We studied the association between transcranial Doppler (TCD) and the outcome.

Methods: This was a pre-defined sub-study of the prospective observational Norwegian Cardiorespiratory Arrest Study. Patients underwent standardized post-resuscitation care, including target temperature management (TTM) to 33°C for 24 h. TCD was performed at days 1, 3, and 5-7. The primary endpoint was cerebral performance category (CPC) at 6 months, dichotomized into good (CPC 1-2) and poor (CPC 3-5) outcomes. We used linear mixed modeling time-series analysis.

Results: Of 139 TCD-examined patients, 81 (58%) had good outcomes. Peak systolic velocity in the middle cerebral artery (PSV) was low during TTM (Day 1) and elevated after rewarming (Day 3). Thereafter, it continued to rise in patients with poor, but normalized in patients with good, outcomes. At days 5-7, PSV was 1.0 m/s (95% CI 0.9; 1.0) in patients with good outcomes and 1.3 m/s (95% CI 1.1; 1.4) in patients with poor outcomes (p < 0.001).

Conclusion: Elevated PSV at days 5-7 indicated poor outcomes. Our findings suggest that serial TCD examinations during the first week after cardiorespiratory arrest may improve our understanding of serious brain injury.

Keywords: brain; brain damage; cardiac arrest (CA); heart; out of hospital arrest; ultrasound.