Abstract Details

Title Assessing the Effects of Cerebral Autoregulation and Neurophysiologic Parameters on Outcomes in aSAH

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P2 - Poster Session 2 (8:00 AM-9:00 AM)

Poster/Presentation
Number 13-016

Objective Determine the relationship between cerebral autoregulation, quantitative electroencephalography, and their effect on outcomes in aneurysmal subarachnoid hemorrhage (aSAH).

Background Deviations from personalized blood pressure targets have been associated with an increased risk of delayed cerebral ischemia (DCI) and worse functional outcomes after aSAH. Quantitative EEG also effectively predicts complications after aSAH. However, the pathophysiologic mechanisms underlying these complications and potential interactions between these two parameters remain unclear.

Design/Methods We included patients with aSAH who were simultaneously monitored with continuous EEG, blood pressure and near-infrared spectroscopy. Autoregulatory function was measured by analyzing changes in regional oxygen saturation in response to changes in mean arterial pressure. The resulting autoregulatory index was utilized to determine and monitor the limits of autoregulation in each patient. EEG band powers, alpha delta ratio, and relative alpha variability were calculated approximating anterior, middle, and posterior cerebral artery territories.

Results Forty-one patients (mean age 55 ±14 years, 68% female, Hunt Hess 3.1±0.9, modified Fisher 3.6 ±0.6) were monitored for a mean duration of 137 ±94 hours. Patients who developed DCI spent more time outside the limits (mean 20.7 ±9.8%) than those who did not (13.8 ±7.7%, p<0.005). Time outside the limits of autoregulation was linked to worse outcomes at discharge (OR per 10%: 2.4, p=0.022) and at 90 days (OR per 10%: 2.5, p=0.015). Decreased ADR was also associated with worse outcome at discharge (OR per 0.1: 1.78, p=0.043) and 90 days (OR per 0.1: 1.80, p=0.041). No significant difference was found in quantitative EEG parameters when blood pressure was below versus within autoregulation limits.

Conclusions Time spent outside autoregulation limits and ADR are associated with worse outcomes after aSAH, but ABP drops below the lower limit did not consistently affect ADR. Further analyses are underway to elucidate the interactions between cerebral autoregulation, neurophysiology, and outcomes.

Authors/Disclosures
David J. Vargas Estrella PRESENTER	Mr. Vargas Estrella has nothing to disclose.
Sithmi M. Jayasundara	Miss Jayasundara has nothing to disclose.
Rafael Maarek	Mr. Maarek has received research support from National Heart Lung & Blood Institute. Mr. Maarek has received research support from Richard K. Gershon Endowed Medical Student Research Fellowship.
Rachel S. Choi (Yale School of Medicine)	Ms. Choi has nothing to disclose.
Yilun Chen (Yale University)	Ms. Chen has nothing to disclose.
Ilayda Top (Yale University)	Ms. Top has nothing to disclose.
Madelynne Olexa	Miss Olexa has nothing to disclose.
Abdelaziz Amllay, MD	Dr. Amllay has nothing to disclose.
Amedeo Rapuano (Yale New Haven Hospital)	Amedeo Rapuano has nothing to disclose.
Jessica Magid-Bernstein, MD, PhD (Yale School of Medicine)	Dr. Magid-Bernstein has nothing to disclose.
Ryan Hebert	Ryan Hebert has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Cerenovus .
Charles Matouk	Charles Matouk has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Silk Road Medical. Charles Matouk has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Microvention. Charles Matouk has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Navigantis.
Kevin N. Sheth, MD, FAAN (Yale UniversityDivision of Neuro and Critical Care)	Dr. Sheth has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Ceribell. Dr. Sheth has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Zoll. Dr. Sheth has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for NControl. Dr. Sheth has received stock or an ownership interest from Astrocyte. Dr. Sheth has received stock or an ownership interest from Alva. The institution of Dr. Sheth has received research support from Biogen. The institution of Dr. Sheth has received research support from Novartis. The institution of Dr. Sheth has received research support from Bard. The institution of Dr. Sheth has received research support from Hyperfine. Dr. Sheth has received intellectual property interests from a discovery or technology relating to health care.
Farhad Bahrassa (Yale Department of Neurosurgery)	Farhad Bahrassa has nothing to disclose.
Rachel Beekman, MD (Yale New Haven Medical Center)	Dr. Beekman has nothing to disclose.
Lena O'Keefe, MD	Dr. O'Keefe has nothing to disclose.
Emily J. Gilmore, MD (Yale University School of Medicine)	Dr. Gilmore has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for carpl.ai. Dr. Gilmore has received personal compensation in the range of $0-$499 for serving as a Consultant for AAN. Dr. Gilmore has received research support from NIH.
Nils Petersen, MD (Yale University)	The institution of Dr. Petersen has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Silkroad Medical. Dr. Petersen has received research support from NIH.
Jennifer A. Kim, MD (Yale University School of Medicine)	Dr. Kim has nothing to disclose.

��ɫ��

��ɫ��