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World J Crit Care Med. Sep 9, 2025; 14(3): 101462
Published online Sep 9, 2025. doi: 10.5492/wjccm.v14.i3.101462
Point of care ultrasound evaluation of cardio-cerebral coupling
Ignacio J Previgliano, Hatem Soliman Aboumarie, Francisco M Tamagnone, Pablo M Merlo, Fernando A Sosa, Jose Feijoo, Maria C Carruega
Ignacio J Previgliano, Department of Neurology, Asociacion Argentina de Ultrasonografia Critica, Buenos Aires 1426, Ciudad Autónoma de, Argentina
Ignacio J Previgliano, Asociacion Argentina de Ultrasonografia Critica research group, Asociacion Argentina de Ultrasonografia Critica, Buenos Aires 1426, Ciudad Autónoma de, Argentina
Hatem Soliman Aboumarie, Department of Anaesthetics and Intensive Care, Harefield Hospital, Royal Brompton and Harefield Hospitals, London UB9 6JH, United Kingdom
Francisco M Tamagnone, President Asociacion Argentina de Ultrasonografia Critica, Buenos Aires 1426, Ciudad Autónoma de, Argentina
Pablo M Merlo, Department of Cardiology, Asociacion Argentina de Ultrasonografia Critica, Buenos Aires 1426, Ciudad Autónoma de, Argentina
Fernando A Sosa, Department of Critical Care, Hospital Aleman, Buenos Aires 1426, Ciudad Autónoma de, Argentina
Jose Feijoo, Department of Research, Asociacion Argentina de Ultrasonografia Critica, Buenos Aires 1426, Ciudad Autónoma de, Argentina
Maria C Carruega, Department of Neurosonology, Asociacion Argentina de Ultrasonografia Critica, Buenos Aires 1426, Ciudad Autónoma de, Argentina
Co-first authors: Ignacio J Previgliano and Hatem Soliman Aboumarie.
Author contributions: Previgliano IJ, Aboumarie HS, Tamagnone FM, Merlo PM, Sosa FA, Feijoo J, and Carruega MC contributed to concept development, first manuscript draft and final manuscript review; Previgliano IJ contributed to pathophysiology and final manuscript edition; Aboumarie HS contributed to English language review; Previgliano IJ and Aboumarie HS contributed equally as co-first authors; Merlo PM contributed to echocardiography and cardiovascular pathophysiology; Sosa FA, Carruega MC, and Feijoo J contributed to bibliographical search and handling; Carruega MC contributed to reference adaptation to journal standards; Feijoo J contributed to graphics edition.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ignacio J Previgliano, MD, Professor, Department of Neurology, Asociacion Argentina de Ultrasonografia Critica, 2676 Virrey Loreto, Buenos Aires 1426, Ciudad Autónoma de, Argentina. iprevigliano@asaruc.org
Received: September 14, 2024
Revised: February 16, 2025
Accepted: March 6, 2025
Published online: September 9, 2025
Processing time: 306 Days and 17.3 Hours
Abstract

Cardio-cerebral coupling (CCC) refers to the dynamic interplay between cardiac function and cerebral blood flow, essential for maintaining hemodynamic stability. Disruptions in CCC are particularly relevant in critical care, where they can exacerbate primary and secondary brain injuries. Ultrasound-based techniques, including transcranial Doppler, transcranial color-coded Doppler, and echocardiography, provide non-invasive methods to assess this relationship at the bedside. This scoping review explores the pathophysiology of CCC, ultrasound methodologies for its evaluation, and its clinical relevance. Key mechanisms such as cerebral autoregulation and neurovascular coupling are discussed, along with ultrasound-derived parameters like pulsatility index, resistance index, and cerebral perfusion pressure. While ultrasound is a valuable tool, its limitations include operator dependency and equipment variability. Emerging evidence suggests that ultrasound-guided protocols, including ultrasound-guided cardio-cerebral resuscitation protocol and ultrasound-guided brain injury treatment protocol, may improve resuscitation strategies and neurocritical care monitoring. Despite its potential, further research is necessary to standardize assessment methods and integrate ultrasound-based CCC evaluation into routine clinical practice. Ongoing multicenter studies are expected to provide robust evidence supporting its clinical utility in managing brain-injured patients.

Keywords: Cardio-cerebral coupling; Transcranial Doppler; Echocardiography; Cerebral blood flow physiology; Cardiovascular physiology; Cerebral autorregulation; Brain circulation assessment

Core Tip: Cardio-cerebral coupling represents the dynamic interplay between cardiac function and cerebral blood flow regulation, crucial for maintaining hemodynamic stability. This article highlights the role of point-of-care ultrasound, including transcranial Doppler, transcranial color-coded Doppler, and echocardiography, in assessing cardio-cerebral coupling at bedside. Ultrasound-derived indices such as pulsatility index, resistance index, and cerebral perfusion pressure offer valuable insights into cerebral autoregulation. While ultrasound is a powerful tool, its clinical utility remains limited by operator dependency and methodological variability. Standardized protocols show promise in optimizing resuscitation strategies and neurocritical care. Further multicenter studies are needed to establish its role in routine clinical practice.