Summary
In children with a traumatic brain injury, the duration of autoregulation impairment correlates with the neurological outcome. This pilot study explored whether a similar relation exists in nontraumatic hypoxic–ischemic brain injury following resuscitation.
We investigated 11 children after resuscitation. Blood pressure and intracranial pressure (ICP) were monitored with ICM+ software and actively managed to maintain optimal cerebral perfusion pressure (CPP), using the pressure reactivity index (PRx). Outcomes were scored according to the Glasgow Outcome Scale.
Three children died within 24 h. Three survivors had an unfavorable outcome and five had a favorable outcome. In the first 72 h, ICP and CPP values did not differ between, or predict, children with favorable or unfavorable outcomes. The duration of a PRx value ≥0.2 was significantly greater in children with an unfavorable outcome. A PRx value ≤0 was associated with a favorable outcome in all except one child. Children with an unfavorable outcome had areas of ischemic brain tissue on magnetic resonance imaging.
The duration of poor autoregulation within the first 72 h is associated with an unfavorable outcome. Prognostic signs for insult severity are initially poor autoregulation plus inability to restore autoregulation despite active attempts to do so. Limited ischemia, especially in the basal ganglia, cannot be detected by ICP-based monitoring of autoregulation and may still result in an unfavorable outcome despite good global autoregulation.
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Zipfel, J., Hockel, K.L., Gerbig, I., Heimberg, E., Schuhmann, M.U., Neunhoeffer, F. (2021). Impaired Autoregulation Following Resuscitation Correlates with Outcome in Pediatric Patients: A Pilot Study. In: Depreitere, B., Meyfroidt, G., Güiza, F. (eds) Intracranial Pressure and Neuromonitoring XVII. Acta Neurochirurgica Supplement, vol 131. Springer, Cham. https://doi.org/10.1007/978-3-030-59436-7_21
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DOI: https://doi.org/10.1007/978-3-030-59436-7_21
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