A novel approach to assess cerebral and coronary perfusion after cardiac arrest

Abstract

Background: Several indices exist to assess cerebral perfusion after cardiac arrest (CA). We aimed to investigate a new approach allowing absolute flow and microvascular resistance measurement based on selective arterial continuous thermodilution before and after CA resuscitation in a porcine model. Methods: In anaesthetised pigs, intravascular absolute cerebral blood flow (CBF) and absolute coronary blood flow (ABF) with corresponding microvascular resistances were measured. CA was induced using overdrive pacing with 3 (group 1, n = 5) or 5 min (group 2, n = 8) of no flow. After resuscitation, CBF was performed at baseline, at 15 min (T15) and at 30 min (T30). Thereafter, CBF in the contralateral cerebral artery and ABF were measured. Results: The protocol could not be completed in three pigs from group 2 due to haemodynamic instability. In the entire cohort, CBF was significantly lower at T30 after CA (0.026 ± 0.02 L/min vs 0.040 ± 0.03 at baseline; p = 0.03) and cerebral microvascular resistances were significantly higher (3202 ± 1838 Woods units vs 2014 ± 1015 at baseline; p = 0.04). ABF and resistances remained stable at baseline, as compared to T30 (0.122 ± 0.05 vs. 0.143 ± 0.06 L/min; p = 0.15 and 563 ± 203 vs. 478 ± 181 Woods units; p = 0.36, respectively). At T30, no significant differences in cerebral flow dynamics were observed between groups. Conclusions: ABF and CBF measurement after CA resuscitation is feasible with thermodilution technique, allowing accurate monitoring and measurements. This novel approach allows simultaneous measurements of flow and microvascular resistances. This animal model simplifies cerebral perfusion measurements and allows to test new therapies to reduce cerebral injury post cardiac arrest.