title: A pilot study of cerebrovascular reactivity autoregulation after pediatric cardiac arrest.
abstract: OBJECTIVE
  Improved survival after cardiac arrest has placed greater emphasis on neurologic resuscitation. The purpose of this pilot study was to evaluate the relationship between cerebrovascular autoregulation and neurologic outcomes after pediatric cardiac arrest.
  
  
  METHODS
  Children resuscitated from cardiac arrest had autoregulation monitoring during the first 72h after return of circulation with an index derived from near-infrared spectroscopy in a pilot study. The range of mean arterial blood pressure (MAP) with optimal vasoreactivity (MAPOPT) was identified. The area under the curve (AUC) of the time spent with MAP below MAPOPT and MAP deviation below MAPOPT was calculated. Neurologic outcome measures included placement of a new tracheostomy or gastrostomy, death from a primary neurologic etiology (brain death or withdrawal of support for neurologic futility), and change in the Pediatric Cerebral Performance Category score (ΔPCPC).
  
  
  RESULTS
  Thirty-six children were monitored. Among children who did not require extracorporeal membrane oxygenation (ECMO), children who received a tracheostomy/gastrostomy had greater AUC during the second 24h after resuscitation than those who did not (P=0.04; n=19). Children without ECMO who died from a neurologic etiology had greater AUC during the first 48h than did those who lived or died from cardiovascular failure (P=0.04; n=19). AUC below MAPOPT was not associated with ΔPCPC when children with or without ECMO were analyzed separately.
  
  
  CONCLUSIONS
  Deviation from the blood pressure with optimal autoregulatory vasoreactivity may predict poor neurologic outcomes after pediatric cardiac arrest. This experimental autoregulation monitoring technique may help individualize blood pressure management goals after resuscitation.
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University (JHU), Baltimore, MD, USA. Electronic address: jklee@jhmi.edu.
authors.forename: Jennifer K
authors.initials: JK
authors.lastname: Lee
authors.affiliation: Department of Anesthesiology, Texas Children's Hospital, Houston, TX, USA.
authors.forename: Ken M
authors.initials: KM
authors.lastname: Brady
authors.affiliation: Department of Pediatrics, Division of General Pediatrics and Adolescent Medicine, JHU, USA; Center for Child and Community Health Research, JHU, USA.
authors.forename: Shang-En
authors.initials: SE
authors.lastname: Chung
authors.affiliation: Department of Pediatrics, Division of General Pediatrics and Adolescent Medicine, JHU, USA; Center for Child and Community Health Research, JHU, USA.
authors.forename: Jacky M
authors.initials: JM
authors.lastname: Jennings
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University (JHU), Baltimore, MD, USA.
authors.forename: Emmett E
authors.initials: EE
authors.lastname: Whitaker
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University (JHU), Baltimore, MD, USA.
authors.forename: Devon
authors.initials: D
authors.lastname: Aganga
authors.affiliation: Department of Anesthesiology, Texas Children's Hospital, Houston, TX, USA.
authors.forename: Ronald B
authors.initials: RB
authors.lastname: Easley
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University (JHU), Baltimore, MD, USA.
authors.forename: Kerry
authors.initials: K
authors.lastname: Heitmiller
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University (JHU), Baltimore, MD, USA.
authors.forename: Jessica L
authors.initials: JL
authors.lastname: Jamrogowicz
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University (JHU), Baltimore, MD, USA.
authors.forename: Abby C
authors.initials: AC
authors.lastname: Larson
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University (JHU), Baltimore, MD, USA.
authors.forename: Jeong-Hoo
authors.initials: JH
authors.lastname: Lee
authors.affiliation: Department of Neurology, Vanderbilt University (VU), Nashville, TN, USA.
authors.forename: Lori C
authors.initials: LC
authors.lastname: Jordan
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University (JHU), Baltimore, MD, USA.
authors.forename: Charles W
authors.initials: CW
authors.lastname: Hogue
authors.affiliation: Department of Pediatrics, VU, USA; Department of Biomedical Informatics, VU, USA.
authors.forename: Christoph U
authors.initials: CU
authors.lastname: Lehmann
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University (JHU), Baltimore, MD, USA.
authors.forename: Mela M
authors.initials: MM
authors.lastname: Bembea
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University (JHU), Baltimore, MD, USA.
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Hunt
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University (JHU), Baltimore, MD, USA.
authors.forename: Raymond C
authors.initials: RC
authors.lastname: Koehler
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University (JHU), Baltimore, MD, USA.
authors.forename: Donald H
authors.initials: DH
authors.lastname: Shaffner
mesh_terms: D000293:Adolescent; D002560:Cerebrovascular Circulation / Q000502:physiology*; D002648:Child; D002675:Child, Preschool; D015199:Extracorporeal Membrane Oxygenation; D005260:Female; D006323:Heart Arrest / Q000503:physiopathology* / Q000628:therapy*; D006706:Homeostasis; D006801:Humans; D007223:Infant; D008297:Male; D010865:Pilot Projects; D012151:Resuscitation
keywords: Blood pressure; Brain injuries; Cerebrovascular circulation; Heart arrest; Pediatrics