Early Transcranial Doppler Goal Directed Therapy After Cardiac Arrest: a Pilot Study

Inclusion Criteria:

• Patients admitted in the Intensive Care Unit (ICU) under mechanical ventilation witha Glasgow Coma Scale ≤ 8/15 after in- or out-of-hospital cardiac arrest

• Mean arterial pressure between 65 and 85 mmHg with or without vasopressor support

Exclusion Criteria:

• Age < 18 years old

• No flow (time between cardiac arrest and the beginning of cardiac massage) > 15minutes or unknown

• Low flow ((time between cardiac arrest and ROSC: return of spontaneous circulation)> 60 minutes

• Time between ROSC and inclusion > 12 hours

• Transcranial doppler unavailable

• Cardiac arrythmia

• Patient under extracorporeal life support before inclusion or at risk of beingreferred for assistance due to cardiogenic shock with high dose of vasopressorsbefore inclusion (MAP < 65 mmHg with norepinephrine or epinephrine > 1 µg/kg/min ordobutamine > 10 µg/kg/min)

• Severe cardiac dysfunction defined by left ventricular ejection fraction < 20% oraortic Velocity Time Integral (VTI: measured with trans-thoracic echocardiography) < 14 cm with dobutamine > 10µg/kg/min

• Patient under Extracorporeal Membrane Oxygenation (ECMO) for Acute RespiratoryDistress Syndrome (ARDS) before inclusion

• Cardiac arrest secondary to brain injury such as stroke, subarachnoid hemorrhage ortraumatic brain injury

• Hemorrhagic shock

• Any acute pathology that requires strict blood pressure control (aortic dissection,stroke, cardiogenic pulmonary edema with high blood pressure)

• Decision of withdrawing or withholding life sustaining treatment before inclusion orconsidered during the first 12 hours of ICU management

• Patient with a modified Rankin scale (MRS) 4 or 5 prior to resuscitation

• Pregnancy or lactation

• Patients already enrolled in another clinical study on cardiac arrest

• Patients with judicial protection

• No social security coverage