Microcirculation Clinical Trial
Official title:
Evaluation of Cerebral Microcirculation Using Non-invasive Contrast-enhanced Ultrasound and Microbubbles Sonovue Administration After Clinical Cardiorespiratory Arrest
Brain microcirculation alterations may be involved in comatose patients and non-survivors after cardiorespiratory arrest. For a three day-period, we investigate brain microcirculation using contrast-enhanced ultrasound with contrast Sonovue injection in patients with successful resuscitation after out-hospital or in-hospital cardiorespiratory arrest.
Brain ultrasound, extracranial echo-color duplex and ocular ultrasound (IE 33, Philips
Medical System, the Netherlands) are performed in the first 24 hours, at 48 hours, and at
72-96 hours after successful resuscitation after out-hospital or in-hospital
cardiorespiratory arrest.
Ultrasound examinations are performed in four steps to 1) evaluate the global cerebral blood
volume, 2) to estimate the presence or absence of cerebral autoregulation, and 3) to
qualitatively evaluate the cerebral perfusion and microcirculation by enhanced microbubbles
contrast injection 4) to qualitatively evaluate the intracranial pressure.
Before performing brain ultrasound, echocardiography (IE 33, Philips medical System, the
Netherlands) is performed to evaluate the cardiac output (L/min).
First, the global cerebral blood volume (L/min) is evaluated as the sum of flow volumes of
the internal carotid (ICA) and vertebral arteries (VA) extracranial arteries of both
sides.The following measurements of flow velocities are taken in each artery: Peak systolic
and end-diastolic velocity, time-averaged velocity (TAV), Pulsatility Index (PI). Flow volume
(Q) of each artery is determined as Q = TAV x Area ((diameter of the artery /2)² x PI).
Brain ultrasound is performed via temporal windows to measure the mean flow velocities
(cm/sec) of the middle cerebral arteries.
Second, the presence or absence of cerebral autoregulation is tested with the Transient
hyperemic response by an ipsilateral common carotid compression one side and another during 5
seconds. Absence of cerebral autoregulation is considered if the flow velocity of the middle
cerebral artery do not increase more than 10% after the compression.
Third, the brain regional microcirculation is evaluated by the microbubbles contrast
injection of Sonovue. The brain parenchyma is insonated via the temporal bone windows at the
depth of 10cm with the ultrasound S5 multifrequency transducer 2-5 Megahertz (MHz) probe.
After optimizing the acoustic bone window, Sonovue is injected intravenously as a bolus 2.4ml
followed by 10ml saline flushed. The contralateral brain is evaluated 5 minutes after the
first injection of Sonovue to allow a complete evacuation of contrast microbubbles.
All real-time images are stored digitally on the hard disk as DICOM (Digital Image
Communications in Medicine) images. Offline imaging analysis using a specific quantification
software named QLAB10 (Philips Medical System, the Netherlands) to convert brain perfusion
images into time-intensity curves (TIC) corresponding to the five different regions of
interest (ROI) of brain parenchyma: anterior and posterior thalamus, lentiform nucleus,
parieto-temporal and posterior white matter. Four variables were extracted from these TIC
curves to qualitatively evaluate the brain microcirculation: peak intensity in dB, time to
peak intensity in seconds, mean transit time in seconds (MTT), and area under the curve in
percentage (AUC).
To qualitatively evaluate the intracranial pressure, ocular ultrasound is performed to
measure the change of the optic nerve sheath diameter(mm). Elevation of intracranial pressure
is considered if this diameter is above 0.55 mm
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