A comparison of non-invasive versus invasive measures of intracranial pressure in hypoxic ischaemic brain injury after cardiac arrest

Danilo Cardim , Donald E. Griesdale , Philip N. Ainslie , Chiara Robba , Leanne Calviello , Marek Czosnyka , Peter Smielewski , Mypinder S. Sekhon

Abstract

AIM: Increased intracranial pressure (ICP) in hypoxic ischaemic brain injury (HIBI) can cause secondary ischaemic brain injury and culminate in brain death. Invasive ICP monitoring is limited by associated risks in HIBI patients. We sought to evaluate the agreement between invasive ICP measurements and non-invasive estimators of ICP (nICP) in HIBI patients. METHODS: Eligible consecutive adult (age > 18) cardiac arrest patients with HIBI were included as part of a single centre prospective interventional study. Invasive ICP monitoring and nICP measurements were undertaken using: a) transcranial Doppler ultrasonography (TCD), b) optic nerve sheet diameter ultrasound (ONSD) and c) jugular venous bulb pressure (JVP). Multiple measurements applied in linear mixed-effects models were considered to obtain the correlation coefficient between ICP and nICP as well as their predictive abilities to detect intracranial hypertension (ICP ≥20 mm Hg). RESULTS: Eleven patients were included (median age of 47 [range 20-71], 8 males and 3 females). There was a linear relationship between ICP and nICP with ONSD (R = 0.53 [p < 0.0001]), JVP (R = 0.38 [p < 0.001]) and TCD (R = 0.30 [p < 0.01]). The ability to predict intracranial hypertension was highest for ONSD and TCD (area under the receiver operating curve (AUC) = 0.96 [95% CI: 0.90-1.00] and AUC = 0.91 [95% CI: 0.83-1.00], respectively). JVP presented the weakest prediction ability (AUC = 0.75 [95% CI: 0.56-0.94]). CONCLUSIONS: ONSD and TCD methods demonstrated agreement with invasively-monitored ICP, suggesting their potential roles in the detection of intracranial hypertension in HIBI after cardiac arrest.
Author Danilo Cardim - [The University of British Columbia]
Danilo Cardim,,
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, Donald E. Griesdale - [The University of British Columbia]
Donald E. Griesdale,,
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, Philip N. Ainslie - [University of British Columbia Okanagan]
Philip N. Ainslie,,
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, Chiara Robba - [Ospedale Policlinico San Martino]
Chiara Robba,,
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, Leanne Calviello - [University of Cambridge]
Leanne Calviello,,
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, Marek Czosnyka (FEIT / PE)
Marek Czosnyka,,
- The Institute of Electronic Systems
, Peter Smielewski - [University of Cambridge]
Peter Smielewski,,
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, Mypinder S. Sekhon - [The University of British Columbia]
Mypinder S. Sekhon,,
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Journal seriesResuscitation, ISSN 0300-9572, (N/A 200 pkt)
Issue year2019
Keywords in EnglishCardiac arrest; Hypoxic ischaemic brain injury; Non-invasive intracranial pressure; Optic nerve sheath diameter ultrasonography; Transcranial doppler ultrasonograph
ASJC Classification2705 Cardiology and Cardiovascular Medicine; 2907 Emergency; 2711 Emergency Medicine
DOIDOI:10.1016/j.resuscitation.2019.01.002
URL https://www.ncbi.nlm.nih.gov/pubmed/30629992
Languageen angielski
Score (nominal)200
Score sourcejournalList
ScoreMinisterial score = 200.0, 31-01-2020, ArticleFromJournal
Publication indicators Scopus Citations = 12; WoS Citations = 1; Scopus SNIP (Source Normalised Impact per Paper): 2017 = 1.993; WoS Impact Factor: 2018 = 4.572 (2) - 2018=5.293 (5)
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