Abstract
Discussion Forum (0)
ePoster
Topic: Brain Injury
Fergusson, Nicholas A1; Hoiland, Ryan L2,3; Thiara, Sonny4; Foster, Denise4; Gooderham, Peter5; Rikhraj, Kiran6; Grunau, Brian6; Christenson, Jim6; Ainslie, Philip N3; Griesdale, Donald EG2,4,7; Sekhon, Mypinder S4
1MD Undergraduate Program, University of British Columbia, Vancouver BC, Canada.
2Department of Anesthesiology, Pharmacology and Therapeutics and Department of Medicine, Division of Critical Care Medicine, University of British Columbia. Vancouver BC, Canada.
3Centre for Heart, Lung, & Vascular Health, School of Health and Exercise Sciences, University of British Columbia – Okanagan. Kelowna, BC, Canada
4Division of Critical Care Medicine, Department of Medicine, Division of Critical Care Medicine, University of British Columbia, Vancouver, BC, Canada
5Division of Neurosurgery, Department of Surgery, University of British Columbia, Vancouver, BC, Canada.
6Department of Emergency Medicine, University of British Columbia, Vancouver, BC, Canada
7Center for Clinical Epidemiology & Evaluation, Vancouver Coastal Health Research Institute, Vancouver BC, Canada
University of British Columbia
Background:
Following return of spontaneous circulation (ROSC) after cardiac arrest, hypoxic ischemic brain injury (HIBI) is the leading cause of mortality and future neurologic disability (1-3). Outcomes among HIBI patients remain dismal (3) with current post resuscitation management advocating for the same generalized physiologic targets in all patients (4). This ‘one size fits all' approach fails to account for underlying individual pathophysiologic differences between patients (5). Goal directed care (GDC) using invasive multimodal neuromonitoring has emerged as a possible resuscitation strategy to optimize cerebral oxygen delivery and utilization (6). Yet, it is unknown whether GDC is associated with improved clinical outcome in post cardiac arrest HIBI patients.
OBJECTIVE
We sought to determine whether GDC using invasive neuromonitoring in HIBI patients after cardiac arrest was associated with improved 6-month neurologic outcome compared to standard of care (SoC). Secondarily, we investigated whether GDC was associated with differences in process of care, clinical management, and physiologic parameters.
Methods:
We conducted a matched cohort study of adult (≥19 years), post cardiac arrest patients with clinical evidence of HIBI treated in the intensive care unit at Vancouver General Hospital between July 5, 2016 and November 30, 2019. We compared patients who underwent GDC using invasive neuromonitoring to those treated with standard of care (SoC) (using both a total and a matched group). We matched SoC patients 1:1 to GDC patients using a combination of exact matching and propensity scores calculated from baseline characteristics. Our primary outcome was 6-month favourable neurologic outcome defined as Cerebral Performance Category (CPC) of 1 or 2.
Results
We included 65 patients, of whom 21 received GDC and 44 patients received SoC. The median age was 50 (interquartile range; 35-61), 48 (74%) were male, and 7 (11%) had shockable rhythms. All GDC patients were matched with 21 SoC patients. The proportion of patients who achieved a favourable neurologic outcome at 6 months was significantly greater in the GDC group (n=9/21 [43%] as compared to the matched (n=2/21 [10%], p=0.016) and total (n=8/44 [18%], p=0.034) SoC groups. Patients in the GDC group had higher median hourly mean arterial pressure (p<0.001 vs. total; p=0.0060 vs. matched) and lower median hourly temperature (p=0.007 vs. total; p=0.041 vs. matched).
Conclusions:
We have conducted the first known comparative analysis of GDC using invasive neuromonitoring in HIBI versus SoC in patients post cardiac arrest. Our findings suggest that GDC using invasive neuromonitoring was associated with a significant increase in favourable neurologic outcome (CPC 1 or 2) at 6 months compared to SoC.
1. Nolan JP, Neumar RW, Adrie C, et al. (2008) Post-cardiac arrest syndrome: epidemiology, pathophysiology, treatment, and prognostication. A Scientific Statement from the International Liaison Committee on Resuscitation; the American Heart Association Emergency Cardiovascular Care Committee; the Coun. Resuscitation 79(3):350–79.
2. Sekhon MS, Ainslie PN, Griesdale DE. (2017) Clinical pathophysiology of hypoxic ischemic brain injury after cardiac arrest: a ' two-hit ' model. Crit Care 21(90):1–10.
3. Zive DM, Schmicker R, Daya M, et al. (2018) Survival and variability over time from out of hospital cardiac arrest across large geographically diverse communities participating in the Resuscitation Outcomes Consortium. Resuscitation 131:74–82.
4. Soar J, Callaway CW, Aibiki M, et al. (2015) Part 4: Advanced life support. Resuscitation. 95:e71–120.
5. Sekhon MS, Griesdale DE. (2017) Individualized perfusion targets in hypoxic ischemic brain injury after cardiac arrest. Crit Care. 21(1):259.
6. Sekhon MS, Gooderham P, Menon DK, et al. (2019) The Burden of Brain Hypoxia and Optimal Mean Arterial Pressure in Patients With Hypoxic Ischemic Brain Injury After Cardiac Arrest. Crit Care Med. Jul;47(7):960-969
Topic: Brain Injury
Fergusson, Nicholas A1; Hoiland, Ryan L2,3; Thiara, Sonny4; Foster, Denise4; Gooderham, Peter5; Rikhraj, Kiran6; Grunau, Brian6; Christenson, Jim6; Ainslie, Philip N3; Griesdale, Donald EG2,4,7; Sekhon, Mypinder S4
1MD Undergraduate Program, University of British Columbia, Vancouver BC, Canada.
2Department of Anesthesiology, Pharmacology and Therapeutics and Department of Medicine, Division of Critical Care Medicine, University of British Columbia. Vancouver BC, Canada.
3Centre for Heart, Lung, & Vascular Health, School of Health and Exercise Sciences, University of British Columbia – Okanagan. Kelowna, BC, Canada
4Division of Critical Care Medicine, Department of Medicine, Division of Critical Care Medicine, University of British Columbia, Vancouver, BC, Canada
5Division of Neurosurgery, Department of Surgery, University of British Columbia, Vancouver, BC, Canada.
6Department of Emergency Medicine, University of British Columbia, Vancouver, BC, Canada
7Center for Clinical Epidemiology & Evaluation, Vancouver Coastal Health Research Institute, Vancouver BC, Canada
University of British Columbia
Background:
Following return of spontaneous circulation (ROSC) after cardiac arrest, hypoxic ischemic brain injury (HIBI) is the leading cause of mortality and future neurologic disability (1-3). Outcomes among HIBI patients remain dismal (3) with current post resuscitation management advocating for the same generalized physiologic targets in all patients (4). This ‘one size fits all' approach fails to account for underlying individual pathophysiologic differences between patients (5). Goal directed care (GDC) using invasive multimodal neuromonitoring has emerged as a possible resuscitation strategy to optimize cerebral oxygen delivery and utilization (6). Yet, it is unknown whether GDC is associated with improved clinical outcome in post cardiac arrest HIBI patients.
OBJECTIVE
We sought to determine whether GDC using invasive neuromonitoring in HIBI patients after cardiac arrest was associated with improved 6-month neurologic outcome compared to standard of care (SoC). Secondarily, we investigated whether GDC was associated with differences in process of care, clinical management, and physiologic parameters.
Methods:
We conducted a matched cohort study of adult (≥19 years), post cardiac arrest patients with clinical evidence of HIBI treated in the intensive care unit at Vancouver General Hospital between July 5, 2016 and November 30, 2019. We compared patients who underwent GDC using invasive neuromonitoring to those treated with standard of care (SoC) (using both a total and a matched group). We matched SoC patients 1:1 to GDC patients using a combination of exact matching and propensity scores calculated from baseline characteristics. Our primary outcome was 6-month favourable neurologic outcome defined as Cerebral Performance Category (CPC) of 1 or 2.
Results
We included 65 patients, of whom 21 received GDC and 44 patients received SoC. The median age was 50 (interquartile range; 35-61), 48 (74%) were male, and 7 (11%) had shockable rhythms. All GDC patients were matched with 21 SoC patients. The proportion of patients who achieved a favourable neurologic outcome at 6 months was significantly greater in the GDC group (n=9/21 [43%] as compared to the matched (n=2/21 [10%], p=0.016) and total (n=8/44 [18%], p=0.034) SoC groups. Patients in the GDC group had higher median hourly mean arterial pressure (p<0.001 vs. total; p=0.0060 vs. matched) and lower median hourly temperature (p=0.007 vs. total; p=0.041 vs. matched).
Conclusions:
We have conducted the first known comparative analysis of GDC using invasive neuromonitoring in HIBI versus SoC in patients post cardiac arrest. Our findings suggest that GDC using invasive neuromonitoring was associated with a significant increase in favourable neurologic outcome (CPC 1 or 2) at 6 months compared to SoC.
1. Nolan JP, Neumar RW, Adrie C, et al. (2008) Post-cardiac arrest syndrome: epidemiology, pathophysiology, treatment, and prognostication. A Scientific Statement from the International Liaison Committee on Resuscitation; the American Heart Association Emergency Cardiovascular Care Committee; the Coun. Resuscitation 79(3):350–79.
2. Sekhon MS, Ainslie PN, Griesdale DE. (2017) Clinical pathophysiology of hypoxic ischemic brain injury after cardiac arrest: a ' two-hit ' model. Crit Care 21(90):1–10.
3. Zive DM, Schmicker R, Daya M, et al. (2018) Survival and variability over time from out of hospital cardiac arrest across large geographically diverse communities participating in the Resuscitation Outcomes Consortium. Resuscitation 131:74–82.
4. Soar J, Callaway CW, Aibiki M, et al. (2015) Part 4: Advanced life support. Resuscitation. 95:e71–120.
5. Sekhon MS, Griesdale DE. (2017) Individualized perfusion targets in hypoxic ischemic brain injury after cardiac arrest. Crit Care. 21(1):259.
6. Sekhon MS, Gooderham P, Menon DK, et al. (2019) The Burden of Brain Hypoxia and Optimal Mean Arterial Pressure in Patients With Hypoxic Ischemic Brain Injury After Cardiac Arrest. Crit Care Med. Jul;47(7):960-969
ePoster
Topic: Brain Injury
Fergusson, Nicholas A1; Hoiland, Ryan L2,3; Thiara, Sonny4; Foster, Denise4; Gooderham, Peter5; Rikhraj, Kiran6; Grunau, Brian6; Christenson, Jim6; Ainslie, Philip N3; Griesdale, Donald EG2,4,7; Sekhon, Mypinder S4
1MD Undergraduate Program, University of British Columbia, Vancouver BC, Canada.
2Department of Anesthesiology, Pharmacology and Therapeutics and Department of Medicine, Division of Critical Care Medicine, University of British Columbia. Vancouver BC, Canada.
3Centre for Heart, Lung, & Vascular Health, School of Health and Exercise Sciences, University of British Columbia – Okanagan. Kelowna, BC, Canada
4Division of Critical Care Medicine, Department of Medicine, Division of Critical Care Medicine, University of British Columbia, Vancouver, BC, Canada
5Division of Neurosurgery, Department of Surgery, University of British Columbia, Vancouver, BC, Canada.
6Department of Emergency Medicine, University of British Columbia, Vancouver, BC, Canada
7Center for Clinical Epidemiology & Evaluation, Vancouver Coastal Health Research Institute, Vancouver BC, Canada
University of British Columbia
Background:
Following return of spontaneous circulation (ROSC) after cardiac arrest, hypoxic ischemic brain injury (HIBI) is the leading cause of mortality and future neurologic disability (1-3). Outcomes among HIBI patients remain dismal (3) with current post resuscitation management advocating for the same generalized physiologic targets in all patients (4). This ‘one size fits all' approach fails to account for underlying individual pathophysiologic differences between patients (5). Goal directed care (GDC) using invasive multimodal neuromonitoring has emerged as a possible resuscitation strategy to optimize cerebral oxygen delivery and utilization (6). Yet, it is unknown whether GDC is associated with improved clinical outcome in post cardiac arrest HIBI patients.
OBJECTIVE
We sought to determine whether GDC using invasive neuromonitoring in HIBI patients after cardiac arrest was associated with improved 6-month neurologic outcome compared to standard of care (SoC). Secondarily, we investigated whether GDC was associated with differences in process of care, clinical management, and physiologic parameters.
Methods:
We conducted a matched cohort study of adult (≥19 years), post cardiac arrest patients with clinical evidence of HIBI treated in the intensive care unit at Vancouver General Hospital between July 5, 2016 and November 30, 2019. We compared patients who underwent GDC using invasive neuromonitoring to those treated with standard of care (SoC) (using both a total and a matched group). We matched SoC patients 1:1 to GDC patients using a combination of exact matching and propensity scores calculated from baseline characteristics. Our primary outcome was 6-month favourable neurologic outcome defined as Cerebral Performance Category (CPC) of 1 or 2.
Results
We included 65 patients, of whom 21 received GDC and 44 patients received SoC. The median age was 50 (interquartile range; 35-61), 48 (74%) were male, and 7 (11%) had shockable rhythms. All GDC patients were matched with 21 SoC patients. The proportion of patients who achieved a favourable neurologic outcome at 6 months was significantly greater in the GDC group (n=9/21 [43%] as compared to the matched (n=2/21 [10%], p=0.016) and total (n=8/44 [18%], p=0.034) SoC groups. Patients in the GDC group had higher median hourly mean arterial pressure (p<0.001 vs. total; p=0.0060 vs. matched) and lower median hourly temperature (p=0.007 vs. total; p=0.041 vs. matched).
Conclusions:
We have conducted the first known comparative analysis of GDC using invasive neuromonitoring in HIBI versus SoC in patients post cardiac arrest. Our findings suggest that GDC using invasive neuromonitoring was associated with a significant increase in favourable neurologic outcome (CPC 1 or 2) at 6 months compared to SoC.
1. Nolan JP, Neumar RW, Adrie C, et al. (2008) Post-cardiac arrest syndrome: epidemiology, pathophysiology, treatment, and prognostication. A Scientific Statement from the International Liaison Committee on Resuscitation; the American Heart Association Emergency Cardiovascular Care Committee; the Coun. Resuscitation 79(3):350–79.
2. Sekhon MS, Ainslie PN, Griesdale DE. (2017) Clinical pathophysiology of hypoxic ischemic brain injury after cardiac arrest: a ' two-hit ' model. Crit Care 21(90):1–10.
3. Zive DM, Schmicker R, Daya M, et al. (2018) Survival and variability over time from out of hospital cardiac arrest across large geographically diverse communities participating in the Resuscitation Outcomes Consortium. Resuscitation 131:74–82.
4. Soar J, Callaway CW, Aibiki M, et al. (2015) Part 4: Advanced life support. Resuscitation. 95:e71–120.
5. Sekhon MS, Griesdale DE. (2017) Individualized perfusion targets in hypoxic ischemic brain injury after cardiac arrest. Crit Care. 21(1):259.
6. Sekhon MS, Gooderham P, Menon DK, et al. (2019) The Burden of Brain Hypoxia and Optimal Mean Arterial Pressure in Patients With Hypoxic Ischemic Brain Injury After Cardiac Arrest. Crit Care Med. Jul;47(7):960-969
Topic: Brain Injury
Fergusson, Nicholas A1; Hoiland, Ryan L2,3; Thiara, Sonny4; Foster, Denise4; Gooderham, Peter5; Rikhraj, Kiran6; Grunau, Brian6; Christenson, Jim6; Ainslie, Philip N3; Griesdale, Donald EG2,4,7; Sekhon, Mypinder S4
1MD Undergraduate Program, University of British Columbia, Vancouver BC, Canada.
2Department of Anesthesiology, Pharmacology and Therapeutics and Department of Medicine, Division of Critical Care Medicine, University of British Columbia. Vancouver BC, Canada.
3Centre for Heart, Lung, & Vascular Health, School of Health and Exercise Sciences, University of British Columbia – Okanagan. Kelowna, BC, Canada
4Division of Critical Care Medicine, Department of Medicine, Division of Critical Care Medicine, University of British Columbia, Vancouver, BC, Canada
5Division of Neurosurgery, Department of Surgery, University of British Columbia, Vancouver, BC, Canada.
6Department of Emergency Medicine, University of British Columbia, Vancouver, BC, Canada
7Center for Clinical Epidemiology & Evaluation, Vancouver Coastal Health Research Institute, Vancouver BC, Canada
University of British Columbia
Background:
Following return of spontaneous circulation (ROSC) after cardiac arrest, hypoxic ischemic brain injury (HIBI) is the leading cause of mortality and future neurologic disability (1-3). Outcomes among HIBI patients remain dismal (3) with current post resuscitation management advocating for the same generalized physiologic targets in all patients (4). This ‘one size fits all' approach fails to account for underlying individual pathophysiologic differences between patients (5). Goal directed care (GDC) using invasive multimodal neuromonitoring has emerged as a possible resuscitation strategy to optimize cerebral oxygen delivery and utilization (6). Yet, it is unknown whether GDC is associated with improved clinical outcome in post cardiac arrest HIBI patients.
OBJECTIVE
We sought to determine whether GDC using invasive neuromonitoring in HIBI patients after cardiac arrest was associated with improved 6-month neurologic outcome compared to standard of care (SoC). Secondarily, we investigated whether GDC was associated with differences in process of care, clinical management, and physiologic parameters.
Methods:
We conducted a matched cohort study of adult (≥19 years), post cardiac arrest patients with clinical evidence of HIBI treated in the intensive care unit at Vancouver General Hospital between July 5, 2016 and November 30, 2019. We compared patients who underwent GDC using invasive neuromonitoring to those treated with standard of care (SoC) (using both a total and a matched group). We matched SoC patients 1:1 to GDC patients using a combination of exact matching and propensity scores calculated from baseline characteristics. Our primary outcome was 6-month favourable neurologic outcome defined as Cerebral Performance Category (CPC) of 1 or 2.
Results
We included 65 patients, of whom 21 received GDC and 44 patients received SoC. The median age was 50 (interquartile range; 35-61), 48 (74%) were male, and 7 (11%) had shockable rhythms. All GDC patients were matched with 21 SoC patients. The proportion of patients who achieved a favourable neurologic outcome at 6 months was significantly greater in the GDC group (n=9/21 [43%] as compared to the matched (n=2/21 [10%], p=0.016) and total (n=8/44 [18%], p=0.034) SoC groups. Patients in the GDC group had higher median hourly mean arterial pressure (p<0.001 vs. total; p=0.0060 vs. matched) and lower median hourly temperature (p=0.007 vs. total; p=0.041 vs. matched).
Conclusions:
We have conducted the first known comparative analysis of GDC using invasive neuromonitoring in HIBI versus SoC in patients post cardiac arrest. Our findings suggest that GDC using invasive neuromonitoring was associated with a significant increase in favourable neurologic outcome (CPC 1 or 2) at 6 months compared to SoC.
1. Nolan JP, Neumar RW, Adrie C, et al. (2008) Post-cardiac arrest syndrome: epidemiology, pathophysiology, treatment, and prognostication. A Scientific Statement from the International Liaison Committee on Resuscitation; the American Heart Association Emergency Cardiovascular Care Committee; the Coun. Resuscitation 79(3):350–79.
2. Sekhon MS, Ainslie PN, Griesdale DE. (2017) Clinical pathophysiology of hypoxic ischemic brain injury after cardiac arrest: a ' two-hit ' model. Crit Care 21(90):1–10.
3. Zive DM, Schmicker R, Daya M, et al. (2018) Survival and variability over time from out of hospital cardiac arrest across large geographically diverse communities participating in the Resuscitation Outcomes Consortium. Resuscitation 131:74–82.
4. Soar J, Callaway CW, Aibiki M, et al. (2015) Part 4: Advanced life support. Resuscitation. 95:e71–120.
5. Sekhon MS, Griesdale DE. (2017) Individualized perfusion targets in hypoxic ischemic brain injury after cardiac arrest. Crit Care. 21(1):259.
6. Sekhon MS, Gooderham P, Menon DK, et al. (2019) The Burden of Brain Hypoxia and Optimal Mean Arterial Pressure in Patients With Hypoxic Ischemic Brain Injury After Cardiac Arrest. Crit Care Med. Jul;47(7):960-969
Goal-Directed Care Using Invasive Neuromonitoring Versus Standard of Care After Cardiac Arrest: A Matched Cohort Study
Nicholas Fergusson
Abstract
Discussion Forum (0)
ePoster
Topic: Brain Injury
Fergusson, Nicholas A1; Hoiland, Ryan L2,3; Thiara, Sonny4; Foster, Denise4; Gooderham, Peter5; Rikhraj, Kiran6; Grunau, Brian6; Christenson, Jim6; Ainslie, Philip N3; Griesdale, Donald EG2,4,7; Sekhon, Mypinder S4
1MD Undergraduate Program, University of British Columbia, Vancouver BC, Canada.
2Department of Anesthesiology, Pharmacology and Therapeutics and Department of Medicine, Division of Critical Care Medicine, University of British Columbia. Vancouver BC, Canada.
3Centre for Heart, Lung, & Vascular Health, School of Health and Exercise Sciences, University of British Columbia – Okanagan. Kelowna, BC, Canada
4Division of Critical Care Medicine, Department of Medicine, Division of Critical Care Medicine, University of British Columbia, Vancouver, BC, Canada
5Division of Neurosurgery, Department of Surgery, University of British Columbia, Vancouver, BC, Canada.
6Department of Emergency Medicine, University of British Columbia, Vancouver, BC, Canada
7Center for Clinical Epidemiology & Evaluation, Vancouver Coastal Health Research Institute, Vancouver BC, Canada
University of British Columbia
Background:
Following return of spontaneous circulation (ROSC) after cardiac arrest, hypoxic ischemic brain injury (HIBI) is the leading cause of mortality and future neurologic disability (1-3). Outcomes among HIBI patients remain dismal (3) with current post resuscitation management advocating for the same generalized physiologic targets in all patients (4). This ‘one size fits all' approach fails to account for underlying individual pathophysiologic differences between patients (5). Goal directed care (GDC) using invasive multimodal neuromonitoring has emerged as a possible resuscitation strategy to optimize cerebral oxygen delivery and utilization (6). Yet, it is unknown whether GDC is associated with improved clinical outcome in post cardiac arrest HIBI patients.
OBJECTIVE
We sought to determine whether GDC using invasive neuromonitoring in HIBI patients after cardiac arrest was associated with improved 6-month neurologic outcome compared to standard of care (SoC). Secondarily, we investigated whether GDC was associated with differences in process of care, clinical management, and physiologic parameters.
Methods:
We conducted a matched cohort study of adult (≥19 years), post cardiac arrest patients with clinical evidence of HIBI treated in the intensive care unit at Vancouver General Hospital between July 5, 2016 and November 30, 2019. We compared patients who underwent GDC using invasive neuromonitoring to those treated with standard of care (SoC) (using both a total and a matched group). We matched SoC patients 1:1 to GDC patients using a combination of exact matching and propensity scores calculated from baseline characteristics. Our primary outcome was 6-month favourable neurologic outcome defined as Cerebral Performance Category (CPC) of 1 or 2.
Results
We included 65 patients, of whom 21 received GDC and 44 patients received SoC. The median age was 50 (interquartile range; 35-61), 48 (74%) were male, and 7 (11%) had shockable rhythms. All GDC patients were matched with 21 SoC patients. The proportion of patients who achieved a favourable neurologic outcome at 6 months was significantly greater in the GDC group (n=9/21 [43%] as compared to the matched (n=2/21 [10%], p=0.016) and total (n=8/44 [18%], p=0.034) SoC groups. Patients in the GDC group had higher median hourly mean arterial pressure (p<0.001 vs. total; p=0.0060 vs. matched) and lower median hourly temperature (p=0.007 vs. total; p=0.041 vs. matched).
Conclusions:
We have conducted the first known comparative analysis of GDC using invasive neuromonitoring in HIBI versus SoC in patients post cardiac arrest. Our findings suggest that GDC using invasive neuromonitoring was associated with a significant increase in favourable neurologic outcome (CPC 1 or 2) at 6 months compared to SoC.
1. Nolan JP, Neumar RW, Adrie C, et al. (2008) Post-cardiac arrest syndrome: epidemiology, pathophysiology, treatment, and prognostication. A Scientific Statement from the International Liaison Committee on Resuscitation; the American Heart Association Emergency Cardiovascular Care Committee; the Coun. Resuscitation 79(3):350–79.
2. Sekhon MS, Ainslie PN, Griesdale DE. (2017) Clinical pathophysiology of hypoxic ischemic brain injury after cardiac arrest: a ' two-hit ' model. Crit Care 21(90):1–10.
3. Zive DM, Schmicker R, Daya M, et al. (2018) Survival and variability over time from out of hospital cardiac arrest across large geographically diverse communities participating in the Resuscitation Outcomes Consortium. Resuscitation 131:74–82.
4. Soar J, Callaway CW, Aibiki M, et al. (2015) Part 4: Advanced life support. Resuscitation. 95:e71–120.
5. Sekhon MS, Griesdale DE. (2017) Individualized perfusion targets in hypoxic ischemic brain injury after cardiac arrest. Crit Care. 21(1):259.
6. Sekhon MS, Gooderham P, Menon DK, et al. (2019) The Burden of Brain Hypoxia and Optimal Mean Arterial Pressure in Patients With Hypoxic Ischemic Brain Injury After Cardiac Arrest. Crit Care Med. Jul;47(7):960-969
Topic: Brain Injury
Fergusson, Nicholas A1; Hoiland, Ryan L2,3; Thiara, Sonny4; Foster, Denise4; Gooderham, Peter5; Rikhraj, Kiran6; Grunau, Brian6; Christenson, Jim6; Ainslie, Philip N3; Griesdale, Donald EG2,4,7; Sekhon, Mypinder S4
1MD Undergraduate Program, University of British Columbia, Vancouver BC, Canada.
2Department of Anesthesiology, Pharmacology and Therapeutics and Department of Medicine, Division of Critical Care Medicine, University of British Columbia. Vancouver BC, Canada.
3Centre for Heart, Lung, & Vascular Health, School of Health and Exercise Sciences, University of British Columbia – Okanagan. Kelowna, BC, Canada
4Division of Critical Care Medicine, Department of Medicine, Division of Critical Care Medicine, University of British Columbia, Vancouver, BC, Canada
5Division of Neurosurgery, Department of Surgery, University of British Columbia, Vancouver, BC, Canada.
6Department of Emergency Medicine, University of British Columbia, Vancouver, BC, Canada
7Center for Clinical Epidemiology & Evaluation, Vancouver Coastal Health Research Institute, Vancouver BC, Canada
University of British Columbia
Background:
Following return of spontaneous circulation (ROSC) after cardiac arrest, hypoxic ischemic brain injury (HIBI) is the leading cause of mortality and future neurologic disability (1-3). Outcomes among HIBI patients remain dismal (3) with current post resuscitation management advocating for the same generalized physiologic targets in all patients (4). This ‘one size fits all' approach fails to account for underlying individual pathophysiologic differences between patients (5). Goal directed care (GDC) using invasive multimodal neuromonitoring has emerged as a possible resuscitation strategy to optimize cerebral oxygen delivery and utilization (6). Yet, it is unknown whether GDC is associated with improved clinical outcome in post cardiac arrest HIBI patients.
OBJECTIVE
We sought to determine whether GDC using invasive neuromonitoring in HIBI patients after cardiac arrest was associated with improved 6-month neurologic outcome compared to standard of care (SoC). Secondarily, we investigated whether GDC was associated with differences in process of care, clinical management, and physiologic parameters.
Methods:
We conducted a matched cohort study of adult (≥19 years), post cardiac arrest patients with clinical evidence of HIBI treated in the intensive care unit at Vancouver General Hospital between July 5, 2016 and November 30, 2019. We compared patients who underwent GDC using invasive neuromonitoring to those treated with standard of care (SoC) (using both a total and a matched group). We matched SoC patients 1:1 to GDC patients using a combination of exact matching and propensity scores calculated from baseline characteristics. Our primary outcome was 6-month favourable neurologic outcome defined as Cerebral Performance Category (CPC) of 1 or 2.
Results
We included 65 patients, of whom 21 received GDC and 44 patients received SoC. The median age was 50 (interquartile range; 35-61), 48 (74%) were male, and 7 (11%) had shockable rhythms. All GDC patients were matched with 21 SoC patients. The proportion of patients who achieved a favourable neurologic outcome at 6 months was significantly greater in the GDC group (n=9/21 [43%] as compared to the matched (n=2/21 [10%], p=0.016) and total (n=8/44 [18%], p=0.034) SoC groups. Patients in the GDC group had higher median hourly mean arterial pressure (p<0.001 vs. total; p=0.0060 vs. matched) and lower median hourly temperature (p=0.007 vs. total; p=0.041 vs. matched).
Conclusions:
We have conducted the first known comparative analysis of GDC using invasive neuromonitoring in HIBI versus SoC in patients post cardiac arrest. Our findings suggest that GDC using invasive neuromonitoring was associated with a significant increase in favourable neurologic outcome (CPC 1 or 2) at 6 months compared to SoC.
1. Nolan JP, Neumar RW, Adrie C, et al. (2008) Post-cardiac arrest syndrome: epidemiology, pathophysiology, treatment, and prognostication. A Scientific Statement from the International Liaison Committee on Resuscitation; the American Heart Association Emergency Cardiovascular Care Committee; the Coun. Resuscitation 79(3):350–79.
2. Sekhon MS, Ainslie PN, Griesdale DE. (2017) Clinical pathophysiology of hypoxic ischemic brain injury after cardiac arrest: a ' two-hit ' model. Crit Care 21(90):1–10.
3. Zive DM, Schmicker R, Daya M, et al. (2018) Survival and variability over time from out of hospital cardiac arrest across large geographically diverse communities participating in the Resuscitation Outcomes Consortium. Resuscitation 131:74–82.
4. Soar J, Callaway CW, Aibiki M, et al. (2015) Part 4: Advanced life support. Resuscitation. 95:e71–120.
5. Sekhon MS, Griesdale DE. (2017) Individualized perfusion targets in hypoxic ischemic brain injury after cardiac arrest. Crit Care. 21(1):259.
6. Sekhon MS, Gooderham P, Menon DK, et al. (2019) The Burden of Brain Hypoxia and Optimal Mean Arterial Pressure in Patients With Hypoxic Ischemic Brain Injury After Cardiac Arrest. Crit Care Med. Jul;47(7):960-969
ePoster
Topic: Brain Injury
Fergusson, Nicholas A1; Hoiland, Ryan L2,3; Thiara, Sonny4; Foster, Denise4; Gooderham, Peter5; Rikhraj, Kiran6; Grunau, Brian6; Christenson, Jim6; Ainslie, Philip N3; Griesdale, Donald EG2,4,7; Sekhon, Mypinder S4
1MD Undergraduate Program, University of British Columbia, Vancouver BC, Canada.
2Department of Anesthesiology, Pharmacology and Therapeutics and Department of Medicine, Division of Critical Care Medicine, University of British Columbia. Vancouver BC, Canada.
3Centre for Heart, Lung, & Vascular Health, School of Health and Exercise Sciences, University of British Columbia – Okanagan. Kelowna, BC, Canada
4Division of Critical Care Medicine, Department of Medicine, Division of Critical Care Medicine, University of British Columbia, Vancouver, BC, Canada
5Division of Neurosurgery, Department of Surgery, University of British Columbia, Vancouver, BC, Canada.
6Department of Emergency Medicine, University of British Columbia, Vancouver, BC, Canada
7Center for Clinical Epidemiology & Evaluation, Vancouver Coastal Health Research Institute, Vancouver BC, Canada
University of British Columbia
Background:
Following return of spontaneous circulation (ROSC) after cardiac arrest, hypoxic ischemic brain injury (HIBI) is the leading cause of mortality and future neurologic disability (1-3). Outcomes among HIBI patients remain dismal (3) with current post resuscitation management advocating for the same generalized physiologic targets in all patients (4). This ‘one size fits all' approach fails to account for underlying individual pathophysiologic differences between patients (5). Goal directed care (GDC) using invasive multimodal neuromonitoring has emerged as a possible resuscitation strategy to optimize cerebral oxygen delivery and utilization (6). Yet, it is unknown whether GDC is associated with improved clinical outcome in post cardiac arrest HIBI patients.
OBJECTIVE
We sought to determine whether GDC using invasive neuromonitoring in HIBI patients after cardiac arrest was associated with improved 6-month neurologic outcome compared to standard of care (SoC). Secondarily, we investigated whether GDC was associated with differences in process of care, clinical management, and physiologic parameters.
Methods:
We conducted a matched cohort study of adult (≥19 years), post cardiac arrest patients with clinical evidence of HIBI treated in the intensive care unit at Vancouver General Hospital between July 5, 2016 and November 30, 2019. We compared patients who underwent GDC using invasive neuromonitoring to those treated with standard of care (SoC) (using both a total and a matched group). We matched SoC patients 1:1 to GDC patients using a combination of exact matching and propensity scores calculated from baseline characteristics. Our primary outcome was 6-month favourable neurologic outcome defined as Cerebral Performance Category (CPC) of 1 or 2.
Results
We included 65 patients, of whom 21 received GDC and 44 patients received SoC. The median age was 50 (interquartile range; 35-61), 48 (74%) were male, and 7 (11%) had shockable rhythms. All GDC patients were matched with 21 SoC patients. The proportion of patients who achieved a favourable neurologic outcome at 6 months was significantly greater in the GDC group (n=9/21 [43%] as compared to the matched (n=2/21 [10%], p=0.016) and total (n=8/44 [18%], p=0.034) SoC groups. Patients in the GDC group had higher median hourly mean arterial pressure (p<0.001 vs. total; p=0.0060 vs. matched) and lower median hourly temperature (p=0.007 vs. total; p=0.041 vs. matched).
Conclusions:
We have conducted the first known comparative analysis of GDC using invasive neuromonitoring in HIBI versus SoC in patients post cardiac arrest. Our findings suggest that GDC using invasive neuromonitoring was associated with a significant increase in favourable neurologic outcome (CPC 1 or 2) at 6 months compared to SoC.
1. Nolan JP, Neumar RW, Adrie C, et al. (2008) Post-cardiac arrest syndrome: epidemiology, pathophysiology, treatment, and prognostication. A Scientific Statement from the International Liaison Committee on Resuscitation; the American Heart Association Emergency Cardiovascular Care Committee; the Coun. Resuscitation 79(3):350–79.
2. Sekhon MS, Ainslie PN, Griesdale DE. (2017) Clinical pathophysiology of hypoxic ischemic brain injury after cardiac arrest: a ' two-hit ' model. Crit Care 21(90):1–10.
3. Zive DM, Schmicker R, Daya M, et al. (2018) Survival and variability over time from out of hospital cardiac arrest across large geographically diverse communities participating in the Resuscitation Outcomes Consortium. Resuscitation 131:74–82.
4. Soar J, Callaway CW, Aibiki M, et al. (2015) Part 4: Advanced life support. Resuscitation. 95:e71–120.
5. Sekhon MS, Griesdale DE. (2017) Individualized perfusion targets in hypoxic ischemic brain injury after cardiac arrest. Crit Care. 21(1):259.
6. Sekhon MS, Gooderham P, Menon DK, et al. (2019) The Burden of Brain Hypoxia and Optimal Mean Arterial Pressure in Patients With Hypoxic Ischemic Brain Injury After Cardiac Arrest. Crit Care Med. Jul;47(7):960-969
Topic: Brain Injury
Fergusson, Nicholas A1; Hoiland, Ryan L2,3; Thiara, Sonny4; Foster, Denise4; Gooderham, Peter5; Rikhraj, Kiran6; Grunau, Brian6; Christenson, Jim6; Ainslie, Philip N3; Griesdale, Donald EG2,4,7; Sekhon, Mypinder S4
1MD Undergraduate Program, University of British Columbia, Vancouver BC, Canada.
2Department of Anesthesiology, Pharmacology and Therapeutics and Department of Medicine, Division of Critical Care Medicine, University of British Columbia. Vancouver BC, Canada.
3Centre for Heart, Lung, & Vascular Health, School of Health and Exercise Sciences, University of British Columbia – Okanagan. Kelowna, BC, Canada
4Division of Critical Care Medicine, Department of Medicine, Division of Critical Care Medicine, University of British Columbia, Vancouver, BC, Canada
5Division of Neurosurgery, Department of Surgery, University of British Columbia, Vancouver, BC, Canada.
6Department of Emergency Medicine, University of British Columbia, Vancouver, BC, Canada
7Center for Clinical Epidemiology & Evaluation, Vancouver Coastal Health Research Institute, Vancouver BC, Canada
University of British Columbia
Background:
Following return of spontaneous circulation (ROSC) after cardiac arrest, hypoxic ischemic brain injury (HIBI) is the leading cause of mortality and future neurologic disability (1-3). Outcomes among HIBI patients remain dismal (3) with current post resuscitation management advocating for the same generalized physiologic targets in all patients (4). This ‘one size fits all' approach fails to account for underlying individual pathophysiologic differences between patients (5). Goal directed care (GDC) using invasive multimodal neuromonitoring has emerged as a possible resuscitation strategy to optimize cerebral oxygen delivery and utilization (6). Yet, it is unknown whether GDC is associated with improved clinical outcome in post cardiac arrest HIBI patients.
OBJECTIVE
We sought to determine whether GDC using invasive neuromonitoring in HIBI patients after cardiac arrest was associated with improved 6-month neurologic outcome compared to standard of care (SoC). Secondarily, we investigated whether GDC was associated with differences in process of care, clinical management, and physiologic parameters.
Methods:
We conducted a matched cohort study of adult (≥19 years), post cardiac arrest patients with clinical evidence of HIBI treated in the intensive care unit at Vancouver General Hospital between July 5, 2016 and November 30, 2019. We compared patients who underwent GDC using invasive neuromonitoring to those treated with standard of care (SoC) (using both a total and a matched group). We matched SoC patients 1:1 to GDC patients using a combination of exact matching and propensity scores calculated from baseline characteristics. Our primary outcome was 6-month favourable neurologic outcome defined as Cerebral Performance Category (CPC) of 1 or 2.
Results
We included 65 patients, of whom 21 received GDC and 44 patients received SoC. The median age was 50 (interquartile range; 35-61), 48 (74%) were male, and 7 (11%) had shockable rhythms. All GDC patients were matched with 21 SoC patients. The proportion of patients who achieved a favourable neurologic outcome at 6 months was significantly greater in the GDC group (n=9/21 [43%] as compared to the matched (n=2/21 [10%], p=0.016) and total (n=8/44 [18%], p=0.034) SoC groups. Patients in the GDC group had higher median hourly mean arterial pressure (p<0.001 vs. total; p=0.0060 vs. matched) and lower median hourly temperature (p=0.007 vs. total; p=0.041 vs. matched).
Conclusions:
We have conducted the first known comparative analysis of GDC using invasive neuromonitoring in HIBI versus SoC in patients post cardiac arrest. Our findings suggest that GDC using invasive neuromonitoring was associated with a significant increase in favourable neurologic outcome (CPC 1 or 2) at 6 months compared to SoC.
1. Nolan JP, Neumar RW, Adrie C, et al. (2008) Post-cardiac arrest syndrome: epidemiology, pathophysiology, treatment, and prognostication. A Scientific Statement from the International Liaison Committee on Resuscitation; the American Heart Association Emergency Cardiovascular Care Committee; the Coun. Resuscitation 79(3):350–79.
2. Sekhon MS, Ainslie PN, Griesdale DE. (2017) Clinical pathophysiology of hypoxic ischemic brain injury after cardiac arrest: a ' two-hit ' model. Crit Care 21(90):1–10.
3. Zive DM, Schmicker R, Daya M, et al. (2018) Survival and variability over time from out of hospital cardiac arrest across large geographically diverse communities participating in the Resuscitation Outcomes Consortium. Resuscitation 131:74–82.
4. Soar J, Callaway CW, Aibiki M, et al. (2015) Part 4: Advanced life support. Resuscitation. 95:e71–120.
5. Sekhon MS, Griesdale DE. (2017) Individualized perfusion targets in hypoxic ischemic brain injury after cardiac arrest. Crit Care. 21(1):259.
6. Sekhon MS, Gooderham P, Menon DK, et al. (2019) The Burden of Brain Hypoxia and Optimal Mean Arterial Pressure in Patients With Hypoxic Ischemic Brain Injury After Cardiac Arrest. Crit Care Med. Jul;47(7):960-969
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