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

Research output: Contribution to journalArticle

2 Citations (Scopus)

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.

Original languageEnglish
JournalResuscitation
DOIs
Publication statusAccepted/In press - Jan 1 2019

Fingerprint

Intracranial Pressure
Heart Arrest
Brain Injuries
Doppler Transcranial Ultrasonography
Optic Nerve
Venous Pressure
Intracranial Hypertension
Area Under Curve
Neck
Brain Death
Prospective Studies

Keywords

  • Cardiac arrest
  • Hypoxic ischaemic brain injury
  • Non-invasive intracranial pressure
  • Optic nerve sheath diameter ultrasonography
  • Transcranial doppler ultrasonography

ASJC Scopus subject areas

  • Emergency Medicine
  • Emergency
  • Cardiology and Cardiovascular Medicine

Cite this

A comparison of non-invasive versus invasive measures of intracranial pressure in hypoxic ischaemic brain injury after cardiac arrest. / Cardim, Danilo; Griesdale, Donald E.; Ainslie, Philip N.; Robba, Chiara; Calviello, Leanne; Czosnyka, Marek; Smielewski, Peter; Sekhon, Mypinder S.

In: Resuscitation, 01.01.2019.

Research output: Contribution to journalArticle

Cardim, Danilo ; Griesdale, Donald E. ; Ainslie, Philip N. ; Robba, Chiara ; Calviello, Leanne ; Czosnyka, Marek ; Smielewski, Peter ; Sekhon, Mypinder S. / A comparison of non-invasive versus invasive measures of intracranial pressure in hypoxic ischaemic brain injury after cardiac arrest. In: Resuscitation. 2019.
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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.",
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T1 - A comparison of non-invasive versus invasive measures of intracranial pressure in hypoxic ischaemic brain injury after cardiac arrest

AU - Cardim, Danilo

AU - Griesdale, Donald E.

AU - Ainslie, Philip N.

AU - Robba, Chiara

AU - Calviello, Leanne

AU - Czosnyka, Marek

AU - Smielewski, Peter

AU - Sekhon, Mypinder S.

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N2 - 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.

AB - 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.

KW - Cardiac arrest

KW - Hypoxic ischaemic brain injury

KW - Non-invasive intracranial pressure

KW - Optic nerve sheath diameter ultrasonography

KW - Transcranial doppler ultrasonography

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