Evidence map›Paper›PMID 40611828›Full record

ArticleResuscitation plus2025

Investigating the dynamics of intracranial pressure and cerebral autoregulation during extracorporeal cardiopulmonary resuscitation using a porcine model.

Tito Porras, Mingfeng Cao, Jessica Briscoe, Jin Kook Kang, Ifeanyi David Chinedozi, Zachary Darby, Shivalika Khanduja, Anastasios Bezerianos, Nitish Thakor, Glenn Whitman and 3 more

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Resuscitation plus, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed.

  1. Review
  2. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

13 authors.

Tito PorrasDivision of Cardiac Surgery, Cardiovascular Surgical Intensive Care, Department of Surgery, Heart and Vascular Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Mingfeng CaoDepartment of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Jessica BriscoeDivision of Cardiac Surgery, Cardiovascular Surgical Intensive Care, Department of Surgery, Heart and Vascular Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Jin Kook KangDepartment of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Ifeanyi David ChinedoziDivision of Cardiac Surgery, Cardiovascular Surgical Intensive Care, Department of Surgery, Heart and Vascular Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Zachary DarbyDivision of Cardiac Surgery, Cardiovascular Surgical Intensive Care, Department of Surgery, Heart and Vascular Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Shivalika KhandujaDepartment of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Anastasios BezerianosBarrow Neurological Institute, Brain Dynamics Laboratory, Phoenix, AZ, USA.
Nitish ThakorDepartment of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Glenn WhitmanDivision of Cardiac Surgery, Cardiovascular Surgical Intensive Care, Department of Surgery, Heart and Vascular Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Debraj MukherjeeDivision of Cardiac Surgery, Cardiovascular Surgical Intensive Care, Department of Surgery, Heart and Vascular Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Steve KellerDivision of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Sung-Min ChoDivision of Cardiac Surgery, Cardiovascular Surgical Intensive Care, Department of Surgery, Heart and Vascular Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA.

Funding

CLots and Oxygen in Va-ExtracorpoReal membrane oxygenation (CLOVER) studyK23HL157610 · NHLBI · JOHNS HOPKINS UNIVERSITY · PI Sung-Min Cho · 2022 to 2026
$797k
NHLBI NIH HHS K23 HL157610
6 · The paper itself

Abstract

Background: Extracorporeal cardiopulmonary resuscitation (ECPR) has emerged as a promising intervention for refractory cardiac arrest, with potential benefits in survival and neurological outcomes. However, the impact of ECPR's rapid, non-pulsatile restoration of cerebral blood flow on intracranial physiology and autoregulation remains poorly understood. Methods: Using a porcine model, this study investigated the dynamics of intracranial pressure (ICP), cerebral autoregulation, and pulsatility during key experimental phases: Baseline, Fibrillation, ECMO, and ROSC. ICP waveform features, including spectral entropy and centroid, were analyzed to assess signal complexity and dominant frequency shifts. Pressure reactivity index (PRx), the correlation between MAP and ICP, was used to assess impaired cerebral autoregulation (PRx > 0.3). Pulsatility, quantified by pulse pressure (PP) and pulsatility index (PI), was evaluated for its interaction with PRx. Results: Significant alterations in ICP and PRx were observed across experimental phases. During Fibrillation, ICP increased, waveforms lost pulsatile structure and complexity, and elevated PRx indicated impaired autoregulation. ECMO initiation resulted in a reduction of ICP fluctuations but reduced pulsatility due to the steady, non-physiological flow. Following ROSC, ICP pulsatility partially recovered, but PRx variability remained high, suggesting inter-subject differences in autoregulatory recovery. Negative correlations between pulsatility and PRx (slope = -0.096, 95% CI: -0.136 to -0.056, Conclusion: This study highlights the complex intracranial changes during ECPR, emphasizing the importance of pulsatility in maintaining cerebral autoregulation. Findings suggest the need for refined ECPR protocols to optimize cerebral protection and improve autoregulatory recovery.

Indexed as

Cardiac arrestCerebral autoregulationECMOECPRPulsatility

Identifiers

PMID40611828
PMCPMC12226061

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.