Understanding of cerebral circulation in cerebral resuscitation and development of therapeutic strategies using machine learning

2023 Fiscal Year Final Research Report

• Project/Area Number: 20K17893
• Research Category: Grant-in-Aid for Early-Career Scientists
• Allocation Type: Multi-year Fund
• Review Section: Basic Section 55060:Emergency medicine-related
• Research Institution: Osaka University
• Principal Investigator: Tachino Jotaro 大阪大学, 大学院医学系研究科, 特任助教(常勤) (50747152)
• Project Period (FY): 2020-04-01 – 2024-03-31
• Keywords: 心停止 / 低酸素性虚血性脳損傷 / 脳血管自動調節能 / 近赤外分光法 / 時間依存性共変量

Outline of Final Research Achievements

In patients resuscitated after out-of-hospital cardiac arrest, non-invasive evaluation of cerebrovascular autoregulation (CVAR) revealed that longer periods of undetectable CVAR significantly increased mortality rates. CVAR, which maintains cerebral blood flow despite changes in blood pressure, was known to decline after cardiac arrest, but its impact on outcomes was unclear. Our research used data from cerebral oxygen saturation and mean arterial pressure to assess CVAR changes over time, using undetectable CVAR duration as a time-dependent covariate in survival analysis. Results indicated that longer undetectable CVAR periods were linked to higher mortality. These findings can aid in predicting neurological outcomes and prevent premature withdrawal of care in potentially recoverable patients. Maintaining proper CVAR post-resuscitation may improve outcomes, highlighting the potential of individualized treatments based on cerebral circulation.

Free Research Field

集中治療、救急医療、外傷、蘇生

Academic Significance and Societal Importance of the Research Achievements

本研究成果には大きく二つの意義がある。第一に、蘇生後早期の臨床データから死亡率の高いサブグループを特定可能となることで、より強化した治療介入を行うべき集団の特定に役立てることができる。さらに、回復する可能性がある方の早期の治療差し控えを回避することに役立つ可能性がある。第二に、脳循環を適正に保つ集中治療管理を行うことが生命予後の改善を示唆するものであり、脳循環に基づいた全身管理方法を開発することが蘇生後の神経後遺症を減じるブレイクスルーとなる可能性があると考えられる。