Predicting the neurological outcome in survivors of cardiopulmonary resuscitation by transcranial Doppler measurement values

Abstract

Background
Post-cardiac arrest brain injury is caused by insufficient cerebral blood flow, which is followed by reperfusion injury and manifested as global brain dysfunction. Neurologic outcome should be determined accurately by proving adequate restoration of the cerebral circulation and oxygen supply.


Aim of work
Evaluate the transcranial Doppler (TCD) measurements as a prognostic tool for neurological outcomes after cardiopulmonary resuscitation (CPR).


Methods
A prospective observational study includes 80 survivors of cardiac arrest with persistent coma after the return of spontaneous circulation (ROSC) admitted to the Critical Care Medicine Department at Cairo University over 22 months. TCD parameters were measured at 24 and 72 h post-CPR and were analyzed compared to Cerebral Performance Category score (CPC).


Results
End diastolic velocity (EDV), mean flow velocity (MFV) and pulsatility index (PI) measurements after 72 h of CPR showed significant correlation with neurologic outcome (P-value < 0.001, 0.021 and < 0.001, r 0.79, 0.65, and 0.93 respectively). While peak systolic velocity (PSV) measurements after 24 and 72 h of CPR did not show significant correlation with neurological outcome (P-value 0.594 and 0.500 respectively). EDV, MFV, and PI showed higher values in patients with favorable outcome in comparison to patients with bad outcome (21.84 vs. 13.46, 46.91 vs. 38.31 and 0.71 vs. 1.27).


Conclusion
TCD measurements can predict favorable neurological outcome after 72 h of CPR via higher values of EDV, MFV, and PI, but this does not apply earlier after 24 h of CPR.