Association Between Deviations From Cerebral Autoregulation-Derived Optimal Blood Pressure and Outcome After Pediatric Cardiac Arrest
Abstract
BACKGROUND AND OBJECTIVES
Cerebrovascular pressure autoregulation (CAR) maintains adequate cerebral blood flow (CBF) despite changes in cerebral perfusion pressure. CAR is disrupted after cardiac arrest, making the brain vulnerable to inadequate perfusion and oxygen delivery at population-derived guideline-recommended blood pressures. A metric of CAR can be used to determine the mean arterial pressure (MAP) at which CAR is most preserved, termed the optimal MAP (MAPopt). Our objective was to determine whether deviations above or below personalized CAR-derived MAPopt after pediatric cardiac arrest are associated with outcomes.
METHODS
We conducted a retrospective analysis of prospectively collected data of patients aged 18 years or younger admitted to the pediatric intensive care unit at Children's Hospital of Philadelphia between October 2018 and December 2023 for post-cardiac arrest care. We computed cerebral oximetry index (COx), a metric of CAR, using a moving, linear correlation between time-synchronized brain tissue oxygenation (StO2) from near-infrared spectroscopy and MAP. A multiwindow weighted algorithm determined each patient's MAPopt over time. We compared each patient's MAP with their CAR-derived MAPopt during the first 72 hours after arrest. Unfavorable outcome was defined as a Pediatric Cerebral Performance Category score of 4-6 at hospital discharge with change of ≥1 from baseline. We tested association between burden (combining magnitude and duration) of MAP…
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