Noninvasive neuromonitoring to guide hemodynamic optimization of cerebral perfusion after return of spontaneous circulation in a swine model of cardiac arrest

无创神经监测指导心脏骤停猪模型自主循环恢复后脑灌注的血流动力学优化

• 批准号: 10591725
• 负责人: Stefan Alexandru Carp
• 金额: $ 46.07万
• 依托单位: MASSACHUSETTS GENERAL HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-15 至 2024-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10591725
• 关键词: Adult; Biological Markers; Blinded; Blood Circulation; Blood Pressure; Blood flow; Bolus Infusion; Brain; Brain Injuries; Brain imaging; Calibration; Cardiopulmonary Resuscitation; Caring; Categories; Cerebral Ischemia; Cerebrovascular Circulation; Cerebrovascular Physiology; Cerebrum; Cessation of life; Clinical Trials; Coma; Data; Development; Diffuse; Edema; Ensure; Family suidae; Frequencies; Goals; Guidelines; Heart Arrest; Hemoglobin; Homeostasis; Hour; Human; Hypoxic-Ischemic Brain Injury; Image; Individual; Intervention; Iodine; Lasers; Light; Measurement; Measures; Methods; Modeling; Monitor; Morbidity - disease rate; Near-Infrared Spectroscopy; Nervous System Physiology; Nervous System Trauma; Neurologic; Neurological outcome; Neuron-Specific Enolase; Newborn Animals; Optical Methods; Optics; Outcome; Oxygen; Oxygen saturation measurement; Patients; Performance; Perfusion; Persons; Pre-Clinical Model; Quantitative Evaluations; Randomized; Recommendation; Reporting; Resuscitation; Scanning; Serology; Serum; Spectrum Analysis; Surrogate Markers; System; Techniques; Testing; Time; Tissues; Transcranial Doppler Ultrasonography; Translating; United States; X-Ray Computed Tomography; base; blood pressure intervention; brain tissue; cerebral oxygenation; hemodynamics; improved; member; mortality; nerve injury; neurofilament; non-invasive monitor; novel; novel strategies; perfusion imaging; personalized medicine; personalized strategies; porcine model; prevent; tissue injury; tissue oxygenation; treatment strategy; white matter

PROJECT SUMMARY More than 500,000 people in the United States suffer a sudden cardiac arrest (CA) each year, and most successfully resuscitated patients ultimately die from hypoxic ischemic brain injury. Given the substantial neurologic morbidity and mortality in patients who remain comatose following resuscitated cardiac arrest, there is a critical need to identify therapies and treatment strategies to reduce neurologic injury in these patients. Cerebral perfusion is an important contributor to neurologic outcomes in resuscitated CA patients who remain comatose following return of spontaneous circulation (ROSC). Therefore, the ability to continuously monitor cerebral perfusion and personalize treatment based on individual perfusion targets is essential. The objective of this proposal is to create a swine cardiac arrest model, and to determine the impact of using cerebral autoregulation-based vs standard MAP targets on cerebral perfusion and neurologic injury. In additional to continuous optical monitoring of cerebral perfusion using diffuse correlation spectroscopy and of cerebral oxygenation using frequency domain near infrared spectrometry, we will invasively monitor tissue oxygenation and perfusion and also obtain 6 hours post-arrest CT scans to evaluate structural measures of tissue injury to confirm optically observed perfusion changes using iodine bolus dynamic scan sequences. Neurological outcomes and neural injury serum biomarkers will be assessed 24 hours post-arrest. We hypothesize that the use of real-time noninvasive measures of cerebral autoregulation (using DCS) to identify and target an individualized optimal MAP (MAPOPT) will improve cerebral perfusion and decrease neurologic injury after a resuscitated cardiac arrest.

项目概要 美国每年有超过 500,000 人遭受心脏骤停 (CA)，其中大多数 成功复苏的患者最终死于缺氧缺血性脑损伤。鉴于实质性 心脏骤停复苏后仍处于昏迷状态的患者的神经系统发病率和死亡率 迫切需要确定减少这些患者神经损伤的疗法和治疗策略。 脑灌注是复苏后仍存活的 CA 患者神经系统结局的重要因素 自主循环恢复（ROSC）后昏迷。因此，持续监控的能力 脑灌注和基于个体灌注目标的个体化治疗至关重要。的目标 该提案旨在创建猪心脏骤停模型，并确定使用大脑的影响 基于自动调节的 MAP 目标与标准 MAP 对脑灌注和神经损伤的影响。除了 使用漫相关光谱法连续光学监测脑灌注和脑灌注 使用频域近红外光谱法进行氧合，我们将侵入性监测组织氧合 和灌注，并获得逮捕后 6 小时的 CT 扫描，以评估组织损伤的结构测量 使用碘丸动态扫描序列确认光学观察到的灌注变化。神经病学 逮捕后 24 小时将评估结果和神经损伤血清生物标志物。我们假设 使用脑自动调节的实时无创测量（使用 DCS）来识别和瞄准 个体化最佳 MAP (MAPOPT) 将改善脑灌注并减少术后神经损伤 心脏骤停复苏。