Objective : To evaluate the clinical value of transcranial color Doppler ultrasound (TCCD) in assessing cerebral function after cardiopulmonary resuscitation (CPR). Methods: A prospective study was conducted in 52 patients with cardiac arrest treated by CPR from January 2018 to January 2020, and its clinical data were analyzed . According to classification of cerebral performance category (CPC), 31 cases (CPC grade 1 - 2) were selected in the good prognosis group and 21 cases (CPC grade 3 - 5) in the poor prognosis group. The cerebral blood flow was measured by transcranial Doppler ultrasound (TCCD) 24 h after CPR, and the differences were compared between the two groups in stroke index, diastolic blood flow velocity (Vd), systolic peak blood flow velocity (Vs) and mean peak blood flow velocity (Vm). The ROC curve of cerebral blood flow after CPR was drawn to predict the prognosis of brain function. Results: The data showed that the pulsatility index of middle cerebral artery of the poor prognosis group decreased within 24 h ; the difference between the two groups was statistically significant (p < 0.05); the Vd, Vs, Vm increased in the good prognosis group ; the difference between the two groups was statistically significant (p < 0.05). The ROC curve of cerebral blood flow after CPR was drawn to predict the prognosis of brain function, and the results showed that the area under the curve and the optimal critical value of cerebral blood flow were 0.731 and 5.69. The sensitivity and specificity were 67.3% and 79.1% respectively. Conclusion: The cerebral blood flow increase in the early stage of successful CPR is positively correlated with the prognosis of cerebral functional resuscitation. Monitoring intracranial blood flow after CPR by TCCD has clinical value to evaluate prognosis of brain function.
Cardiopulmonary resuscitation (CPR) is the only effective treatment for cardiac arrest. With the development of CPR technology in China, the success rate of CPR has increased. Nevertheless, in practice, it was found that 45% - 70% of the surviving patients after CPR developed ischemic hypoxic encephalopathy, showing severe neurological impairment and even brain death [
First, confirm that you have the correct template for your paper size. This template has been tailored for output on the custom paper size (21 cm * 28.5 cm). This prospective observational study was performed in the emergency department of the Hebei General hospital from January 2018 and January 2020. Fifty-two patients suffering from cardiac arrest treated by CPR were included. They were successfully resuscitated from cardiac arrest and their clinical data were analyzed retrospectively. But return of spontaneous circulation (ROSC) does not automatically restore cerebral perfusion. This renders the brain at risk for ischemia and secondary brain injury. There were 35 males (67.31%) and 17 females (32.69%), aged from 21 to 79 (48.86 ± 20.3) years old. Etiology: cardiovascular diseases in 18 cases (34.62%), acute poisoning in 12 cases (23.08%), respiratory diseases in 11 cases (21.15%), cerebrovascular diseases in 7 cases (13.46%), and other diseases in 4 cases (7.69%). Inclusion criteria: Patients who recovered spontaneous circulation after CPR in our department. 1) Age ≥ 18 years old; 2) At least one intact eyeball; 3) No ophthalmic, cervical vascular and craniocerebral surgery in the last 12 months. Exclusion criteria [
| Grading | Neurofunctional manifestations | Clinical manifestations |
|---|---|---|
| CPC 1 | Good cerebral performance: | Conscious, alert, able to work, might have mild neurologic or psychologic deficit. |
| CPC 2 | Moderate cerebral disability | Conscious, sufficient cerebral function for independent activities of daily life. Able to work in sheltered environment. |
| CPC 3 | Severe cerebral disability | Conscious, dependent on others for daily support because of impaired brain function. Ranges from ambulatory state to severe demaletia or paralysis. |
| CPC 4 | Coma or vegetative state | Any degree of coma without the presence of all brain death criteria. Unawareness, even if appears awake (vegetative state) without interaction with environment; may have spontaneous eye opening and sleep/awake cycles. Cerebral unresponsiveness. |
| CPC 5 | Brain death | Apnea, areflexia, EEG silence, etc. |
cases (the good prognosis group, CPC 1 - 2) and 21 cases (the poor prognosis group, CPC 3 - 5). This study was approved by the hospital ethics committee. All cases in this study were examined and treated with informed consent signed by patients and their families.
The template is used to format your paper and style the text. All margins, column widths, line spaces, and text fonts are prescribed; please do not alter them. You may note peculiarities. For example, the head margin in this template measures proportionately more than is customary. This measurement and others are deliberate, using specifications that anticipate your paper as one part of the entire journals, and not as an independent document. Please do not revise any of the current designations.
TCCD monitoring: Patients in supine position, who were placed 4MHz Doppler probes from the external orbital margin and temporal window between ears within 24 h after successful CPR. The temporal window between the outer edge of the orbit, the ear and the left zygomatic arch was taken as the observation point to obtain the best middle cerebral artery blood flow signal. Record the PI value and refer to formula 10/1.47 PI and calculate cerebral blood flow [
The Vd, Vs, Vm, PI of middle cerebral artery was recorded within 24 h after successful CPR in the good prognosis group and the poor prognosis group. Draw the ROC curve of cerebral blood flow after CPR to predict the prognosis of brain function.
All data were analyzed by SPSS 20.0 statistical software. The measured data were represented by mean standard deviation ( x ¯ ± s), independent sample T test was used for the comparison between the two groups of data with normal distribution and homogeneity of variance, and non-parametric test was used for the comparison between two groups that did not conform to normal distribution. Pearson correlation analysis was used for normal distribution data and χ2 test was used for counting data. P < 0.05 was statistically significant.
In the good prognosis group, 22 male, 9 female, the mean age (46.4 ± 21.81) years; Etiology: Cardiovascular disease in 10 cases, Acute poisoning in 8 cases, Respiratory diseases in 7 cases; Cerebrovascular disease in 4 cases, other diseases in 2 cases. In the poor prognosis group, 13 male, 8 female, the mean age (47.8 ± 18.92) years; Etiology: Cardiovascular disease in 8 case, Acute poisoning in 4 cases, Respiratory diseases in 4 cases, Cerebrovascular disease in 3 cases, other diseases in 2 cases. General data between groups were not statistically significant (p > 0.05) (
The parameter of cerebral blood flow within 24 h showed that the diastolic blood flow velocity (Vd), systolic peak blood flow velocity (Vs) and mean peak blood flow velocity (Vm) significantly increased in the good prognosis group, and were statistically significant compared with the poor prognosis group (p < 0.05) (
| the good prognosis group n (%) | the poor prognosis group n (%) | P value | |
|---|---|---|---|
| Cases (n = 52) | 31 (59.6%) | 21 (40.4%) | |
| Age (years) | 46.4 ± 21.81 | 47.8 ± 18.92 | 0.119 |
| Gender (male/female) | 22/9 | 13/8 | 0.515 |
| Cardiovascular and Cerebrovascular Diseases (n = 18) | 10 (19.23%) | 8 (15.38%) | 0.302 |
| Acute poisoning (n = 12) | 8 (15.38%) | 4 (7.69%) | 0.551 |
| Diseases of the respiratory system (n = 11) | 7 (13.46%) | 4 (7.69%) | |
| Cerebrovascular disease (n = 7) | 4 (7.69%) | 3 (5.76%) | 0.452 |
| Other diseases (n = 4) | 2 (3.84%) | 2 (3.84%) | |
| Initial monitoring of body temperature ( x ¯ ± s) | 36.81 ± 1.41 | 37.01 ± 1.55 | 0.154 |
| GCS* score ICU entry ( x ¯ ± s) | 4.27 ± 1.24 | 3.21 ± 1.14 | 0.125 |
| CPC score ( x ¯ ± s) | 1.67 ± 0.82 | 4.70 ± 0.48 | 0.001 |
*GCS: Glasgow Coma Scale.
Compared with the poor prognosis group, the median cerebral artery pulsatility index of the good prognosis group decreased significantly, blood flow increased, and were statistically significant (p < 0.05) (
Draw the ROC curve of cerebral blood flow after CPR to predict the prognosis of cerebral function. The results showed that the area under the curve and the optimal critical value of cerebral blood flow were 0.731 and 5.69. The sensitivity and specificity were 67.3% and 79.1% respectively (
| Group (n = 52) | Vd (cm/s) | Vs (cm/s) | Vm (cm/s) |
|---|---|---|---|
| Adverse group (n = 21) | 26.1 ± 15.4 | 74.8 ± 27.8 | 42.9 ± 18.1 |
| the good prognosis group (n = 31) | 43.5 ± 30.1* | 112.1 ± 44.3* | 70.1 ± 34.0* |
| t value | 3.520 | 3.657 | 3.842 |
| P value | 0.002 | 0.000 | 0.000 |
*indicated significant difference compared with the poor prognosis group at P < 0.05.
| Group | PI of pulsatility index in middle cerebral artery | Cerebral blood flow |
|---|---|---|
| the good prognosis group (n = 31) | 1.35 ± 0.86 | 5.14 ± 1.13 |
| Adverse group (n = 21) | 1.95 ± 0.66 | 4.17 ± 1.21 |
| t value | −3.81 | 4.12 |
| P value | <0.05 | <0.05 |
Cardiac arrest is a common clinical emergency, which occurs in patients with cardiovascular disease, acute poisoning, cerebrovascular disease and respiratory diseases. Although more than half of the patients received standardized CPR and spontaneous circulation recovery was successfully restored [
Transcranial color bifunctional ultrasound (TCCD) can intuitively understand cerebral perfusion in patients after CPR by Dynamic monitoring of cerebral blood flow after CPR, such as diastolic blood flow velocity (Vd), systolic peak blood flow velocity (Vs), mean peak blood flow velocity (Vm), resistance index (RI) and pulsatility index (pulsatility index) of the middle cerebral artery [
According to this study, in the good prognosis group, the patients whose consciousness were restored after CPR, the diastolic blood flow velocity (Vd), systolic peak blood flow velocity (Vs) and mean peak blood flow velocity (Vm) were significantly increased in 24 h compared with the poor prognosis group (p < 0.05), the pulsatility index of middle cerebral artery decreased significantly in the good prognosis group (p < 0.05), the value of which is used to predict the resistance; Draw the ROC curve of cerebral blood flow after CPR in predicting the prognosis of brain function. The results showed that the area and the optimal critical value of cerebral blood flow curve were 0.735 and 5.671, Sensitivity and specificity were 67.2% and 77.9%, respectively, and this was consistent with most clinical reports [
Both cerebral hypoperfusion and cerebral congestion after CPR can cause secondary brain injury, which cannot maintain effective brain metabolism, while cerebral perfusion is closely related to intracranial pressure and cerebral blood flow. Therefore, in recent years, the evaluation of cerebral perfusion and brain function by dynamic monitoring of cerebral blood flow is advocated [
The cerebral blood flow increase in the early stage of successful CPR is positively correlated with the prognosis of cerebral functional resuscitation. Monitoring intracranial blood flow after CPR has clinical value to evaluate prognosis of brain function by TCCD which is safe, non-invasive and repeated at the bedside.
Although the results show a good predictive effect, due to the small sample size and the lack of prospective comparison with other monitoring methods, the conclusion has certain limitations. This is one of our next research directions.
All authors report no conflicts of interest related to this study.
Hui Guo wrote the paper; Jianguo Li carried out the conception of the article; Qian Zhao and Zhangshun Shen consulted the materials and revised them.
This study is supported by the 2019 Medical Science Research Project of Hebei Province (No. 20190202).
Guo, H., Shen, Z.S., Xu, N., Zhao, Q., Li, H.L., Jia, Y.J. and Li, J.G. (2020) Evaluation of Prognosis of Brain Function with Early Transcranial Color Doppler Ultrasound in Patients after Cardiopulmonary Resuscitation. World Journal of Cardiovascular Diseases, 10, 658-665. https://doi.org/10.4236/wjcd.2020.109063