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(Stroke. 1997;28:1569-1573.)
© 1997 American Heart Association, Inc.

Articles

Cerebrovascular Reactivity in Comatose Patients Resuscitated From a Cardiac Arrest

Gerba Buunk, MD; Johannes G. van der Hoeven, MD, PhD Arend E. Meinders, MD, PhD

From the Department of General Internal Medicine (Medical Intensive Care Unit), University Hospital Leiden, the Netherlands.

Correspondence to Gerba Buunk, MD, Medical Intensive Care Unit, C6-Q, Albinusdreef 2, PO Box 9600, 2333 ZA Leiden, Netherlands. E-mail snoeken{at}worldonline.nl

Background and Purpose Cerebral blood flow after cardiac arrest is reduced during the delayed hypoperfusion phase, while cerebral metabolic rate of oxygen returns to baseline values. Hypocapnia can induce cerebral ischemia in neurosurgical patients who already have reduced cerebral blood flow. The purpose of the present study was to determine whether comatose patients resuscitated from a cardiac arrest have a normal cerebrovascular reactivity to changes in Paco₂ and whether hypocapnia causes cerebral ischemia.

Methods We measured mean flow velocity (MFV) and pulsatility index (PI) in the middle cerebral artery, jugular bulb oxygen saturation (SjbO₂), and arterial-jugular lactate difference (AJLD) during normo-, hypo-, and hyperventilation in 10 comatose patients resuscitated from a cardiac arrest. The first measurements were made within 6 hours after cardiac arrest and repeated 6, 12, and 24 hours later.

Results During hypoventilation we observed a significant decrease in PI and an increase in MFV and SjbO₂. During hyperventilation PI and MFV did not change, but SjbO₂ showed a significant decrease. This was accompanied by an increase in AJLD, suggesting cerebral ischemia. In four patients the SjbO₂ decreased below the ischemic threshold of 55%.

Conclusions The cerebrovascular reactivity to changes in arterial carbon dioxide tension is preserved in comatose patients resuscitated from a cardiac arrest. Hyperventilation may induce cerebral ischemia in the postresuscitation period.

Key Words: cardiac arrest • cerebral blood flow • carbon dioxide tension

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