{"database":"biostudies-literature","file_versions":[],"scores":null,"additional":{"submitter":["Kirschen MP"],"funding":["National Heart, Lung, and Blood Institute","NHLBI NIH HHS","NINDS NIH HHS","National Institutes of Health"],"pagination":["110-118"],"full_dataset_link":["https://www.ebi.ac.uk/biostudies/studies/S-EPMC9150719"],"repository":["biostudies-literature"],"omics_type":["Unknown"],"volume":["168"],"pubmed_abstract":["<h4>Aim</h4>Evaluate cerebrovascular autoregulation (CAR) using near-infrared spectroscopy (NIRS) after pediatric cardiac arrest and determine if deviations from CAR-derived optimal mean arterial pressure (MAP<sub>opt</sub>) are associated with outcomes.<h4>Methods</h4>CAR was quantified by a moving, linear correlation between time-synchronized mean arterial pressure (MAP) and regional cerebral oxygenation, called cerebral oximetry index (COx). MAP<sub>opt</sub> was calculated using a multi-window weighted algorithm. We calculated burden (magnitude and duration) of MAP less than 5 mmHg below MAP<sub>opt</sub> (MAPopt - 5), as the area between MAP and MAPopt - 5 curves using numerical integration and normalized as percentage of monitoring duration. Unfavorable outcome was defined as death or pediatric cerebral performance category (PCPC) at hospital discharge ≥3 with ≥1 change from baseline. Univariate logistic regression tested association between burden of MAP less than MAPopt - 5 and outcome.<h4>Results</h4>Thirty-four children (median age 2.9 [IQR 1.5,13.4] years) were evaluated. Median COx in the first 24 h post-cardiac arrest was 0.06 [0,0.20]; patients spent 27% [19,43] of monitored time with COx ≥ 0.3. Patients with an unfavorable outcome (n = 24) had a greater difference between MAP and MAPopt - 5 (13 [11,19] vs. 9 [8,10] mmHg, p = 0.01) and spent more time with MAP below MAPopt - 5 (38% [26,61] vs. 24% [14,28], p = 0.03). Patients with unfavorable outcome had a higher burden of MAP less than MAPopt - 5 than patients with favorable outcome in the first 24 h post-arrest (187 [107,316] vs. 62 [43,102] mmHg × Min/Hr; OR 4.93 [95% CI 1.16-51.78]).<h4>Conclusions</h4>Greater burden of MAP below NIRS-derived MAPopt - 5 during the first 24 h after cardiac arrest was associated with unfavorable outcomes."],"journal":["Resuscitation"],"pubmed_title":["Deviations from NIRS-derived optimal blood pressure are associated with worse outcomes after pediatric cardiac arrest."],"pmcid":["PMC9150719"],"funding_grant_id":["K23HL148541","K23 NS116120","K23 HL148541"],"pubmed_authors":["Kilbaugh T","Baker W","Topjian A","Burnett R","Morgan RW","Lourie K","Agarwal K","Diaz-Arrastia R","Berg R","Sutton R","Balu R","Kirschen MP","Majmudar T","Beaulieu F","Ko T","Shaik M"],"additional_accession":[]},"is_claimable":false,"name":"Deviations from NIRS-derived optimal blood pressure are associated with worse outcomes after pediatric cardiac arrest.","description":"<h4>Aim</h4>Evaluate cerebrovascular autoregulation (CAR) using near-infrared spectroscopy (NIRS) after pediatric cardiac arrest and determine if deviations from CAR-derived optimal mean arterial pressure (MAP<sub>opt</sub>) are associated with outcomes.<h4>Methods</h4>CAR was quantified by a moving, linear correlation between time-synchronized mean arterial pressure (MAP) and regional cerebral oxygenation, called cerebral oximetry index (COx). MAP<sub>opt</sub> was calculated using a multi-window weighted algorithm. We calculated burden (magnitude and duration) of MAP less than 5 mmHg below MAP<sub>opt</sub> (MAPopt - 5), as the area between MAP and MAPopt - 5 curves using numerical integration and normalized as percentage of monitoring duration. Unfavorable outcome was defined as death or pediatric cerebral performance category (PCPC) at hospital discharge ≥3 with ≥1 change from baseline. Univariate logistic regression tested association between burden of MAP less than MAPopt - 5 and outcome.<h4>Results</h4>Thirty-four children (median age 2.9 [IQR 1.5,13.4] years) were evaluated. Median COx in the first 24 h post-cardiac arrest was 0.06 [0,0.20]; patients spent 27% [19,43] of monitored time with COx ≥ 0.3. Patients with an unfavorable outcome (n = 24) had a greater difference between MAP and MAPopt - 5 (13 [11,19] vs. 9 [8,10] mmHg, p = 0.01) and spent more time with MAP below MAPopt - 5 (38% [26,61] vs. 24% [14,28], p = 0.03). Patients with unfavorable outcome had a higher burden of MAP less than MAPopt - 5 than patients with favorable outcome in the first 24 h post-arrest (187 [107,316] vs. 62 [43,102] mmHg × Min/Hr; OR 4.93 [95% CI 1.16-51.78]).<h4>Conclusions</h4>Greater burden of MAP below NIRS-derived MAPopt - 5 during the first 24 h after cardiac arrest was associated with unfavorable outcomes.","dates":{"release":"2021-01-01T00:00:00Z","publication":"2021 Nov","modification":"2025-04-04T09:41:26.007Z","creation":"2025-04-04T09:41:26.007Z"},"accession":"S-EPMC9150719","cross_references":{"pubmed":["34600027"],"doi":["10.1016/j.resuscitation.2021.09.023"]}}