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Post-cardiac arrest brain

Iain Mactier, Jonathan R Dalzell, David Carrick
CLINICAL INTRODUCTION: A 50-year-old woman presented with an inferoposterior ST-elevation myocardial infarction (STEMI) and underwent emergency percutaneous coronary intervention (PCI). Angiography revealed acute occlusion of the circumflex and right coronary (RCA) arteries. PCI was uncomplicated. Her medical history included asthma, hypertension and chronic sinusitis.Three months later, she presented with a non-STEMI (NSTEMI), and angiogram showed a new focal stenosis in the left anterior descending artery...
February 14, 2019: Heart: Official Journal of the British Cardiac Society
Florian Ebner, Susann Ullén, Anders Åneman, Tobias Cronberg, Niklas Mattsson, Hans Friberg, Christian Hassager, Jesper Kjærgaard, Michael Kuiper, Paolo Pelosi, Johan Undén, Matt P Wise, Jørn Wetterslev, Niklas Nielsen
OBJECTIVE: Exposure to hyperoxemia and hypoxemia is common in out-of-hospital cardiac arrest (OHCA) patients following return of spontaneous circulation (ROSC), but its effects on neurological outcome are uncertain, and study results are inconsistent. METHODS: Exploratory post hoc substudy of the Target Temperature Management (TTM) trial, including 939 patients after OHCA with return of spontaneous circulation (ROSC). The association between serial arterial partial pressures of oxygen (PaO2 ) during 37 h following ROSC and neurological outcome at 6 months, evaluated by Cerebral Performance Category (CPC), dichotomized to good (CPC 1-2) and poor (CPC 3-5), was investigated...
January 28, 2019: Critical Care: the Official Journal of the Critical Care Forum
Jung Soo Park, Yeonho You, Jin Hong Min, Insool Yoo, Wonjoon Jeong, Yongchul Cho, Seung Ryu, Jinwoong Lee, Seung Whan Kim, Sung Uk Cho, Se Kwang Oh, Hong Joon Ahn, Junwan Lee, In Ho Lee
AIM: We aimed to evaluate the onset of severe blood-brain barrier (BBB) disruption using cerebrospinal fluid/serum albumin quotient (Qa) in cardiac arrest patients treated with target temperature management (TTM). METHODS: This was a prospective single-centre observational cohort study from October 2017 to September 2018 with the primary endpoint being the onset of severe BBB disruption, determined based on Qa in cardiac arrest patients treated with TTM. Enrolled patients were grouped according to neurologically good and poor outcomes using the cerebral performance category (CPC) at 3 months after return of spontaneous circulation (ROSC)...
October 26, 2018: Resuscitation
Zhuoran Wang, Wei Yang
Brain ischemia induced by cardiac arrest or ischemic stroke is a severe form of metabolic stress that substantially disrupts cellular homeostasis, especially protein homeostasis (proteostasis). As proteostasis is fundamental for cellular and organismal health, cells have developed a complex network to restore proteostasis impaired by stress. Many components of this network - including ubiquitination, small ubiquitin-like modifier (SUMO) conjugation, autophagy, and the unfolded protein response (UPR) - are activated in the post-ischemic brain, and play a crucial role in cell survival and recovery of neurologic function...
December 29, 2018: Neurochemistry International
Kei Hayashida, Aranya Bagchi, Yusuke Miyazaki, Shuichi Hirai, Divya Seth, Michael G Silverman, Emanuele Rezoagli, Eizo Marutani, Naohiro Mori, Aurora Magliocca, Xiaowen Liu, Lorenzo Berra, Allyson G Hindle, Michael W Donnino, Rajeev Malhotra, Matthews O Bradley, Jonathan S Stamler, Fumito Ichinose
BACKGROUND: The biological effects of nitric oxide are mediated via protein S-nitrosylation. Levels of S-nitrosylated protein are controlled in part by the denitrosylase S-nitrosoglutathione reductase (GSNOR). The objective of this study was to examine whether GSNOR inhibition improves outcomes after cardiac arrest and cardiopulmonary resuscitation (CA/CPR). METHODS: Adult wild-type (WT) C57BL/6 and GSNOR-deleted (GSNOR-/- ) mice were subjected to potassium chloride-induced cardiac arrest and subsequently resuscitated...
October 4, 2018: Circulation
Ji Hoon Kim, Min Joung Kim, Je Sung You, Hye Sun Lee, Yoo Seok Park, In Cheol Park, Sung Phil Chung
AIM: Since the introduction of targeted temperature management (TTM), the accuracy and timing of prognostic tests for post-cardiac arrest patients have changed. Although previous studies have demonstrated the effectiveness of a multimodal approach in assessing the prognosis of TTM patients, few studies have investigated an optimised strategy that sequentially combines different prognostic modalities. This study identified an optimal sequential combination of prognostic modalities to predict poor neurologic outcomes in patients undergoing TTM...
December 15, 2018: Resuscitation
Christopher Jou, Rian Shah, Andrew Figueroa, Jignesh K Patel
INTRODUCTION: Post-cardiac arrest syndrome (PCAS) is characterized by systemic ischemia/reperfusion injury, anoxic brain injury, and post-arrest myocardial dysfunction superimposed on a precipitating pathology. The role of inflammatory cytokines in cardiac arrest remains unclear. AIMS: We aimed to describe, with an emphasis on clinical applications, what is known about the role of inflammatory cytokines in cardiac arrest. DATA SOURCES: A PubMed literature review was performed for relevant articles...
December 10, 2018: Journal of Intensive Care Medicine
Caitlin R Woolcott, Stephanie Torrey, Patricia V Turner, Heather Chalmers, Lena J Levison, Karen Schwean-Lardner, Tina M Widowski
Our objective was to determine the efficacy of manual cervical dislocation vs. a mechanical cervical dislocation device for on-farm killing of poults and young turkeys. Forty-two 1- and 3-week old turkeys were randomly assigned to one of three experimental groups: awake manual cervical dislocation (CD), anesthetized manual cervical dislocation (aCD), or anesthetized mechanical cervical dislocation (MCD). Anesthetized birds received an intramuscular dose of 0.3 mg/kg medetomidine and 30 mg/kg of ketamine to achieve a light plane of anesthesia...
2018: Frontiers in Veterinary Science
Shaoyun Liu, Jiefeng Xu, Yuzhi Gao, Peng Shen, Senlin Xia, Zilong Li, Mao Zhang
Background: Post-cardiac arrest syndrome, which has no specific curative treatment, contributes to the high mortality rate of victims who suffer traumatic cardiac arrest (TCA) and initially can be resuscitated. In the present study, we investigated the potential of ulinastatin to mitigate multiple organ injury after resuscitation in a swine TCA model. Methods: Twenty-one male pigs were subjected to hemodynamic shock (40% estimated blood loss in 20 min) followed by cardiac arrest (electrically induced ventricular fibrillation) and respiratory suspension for 5 min, and finally manual resuscitation...
2018: World Journal of Emergency Surgery: WJES
Krithiga Sekar, Nicholas D Schiff, Douglas Labar, Peter B Forgacs
PURPOSE: To assess the potential biologic significance of variations in burst-suppression patterns (BSPs) after cardiac arrest in relation to recovery of consciousness. In the context of recent theoretical models of BSP, bursting frequency may be representative of underlying network dynamics; discontinuous activation of membrane potential during impaired cellular energetics may promote neuronal rescue. METHODS: We reviewed a database of 73 comatose post-cardiac arrest patients who underwent therapeutic hypothermia to assess for the presence of BSP and clinical outcomes...
November 12, 2018: Journal of Clinical Neurophysiology: Official Publication of the American Electroencephalographic Society
A Almojuela, M Hasen, F A Zeiler
BACKGROUND: The Full Outline of UnResponsivness (FOUR) score is a neurological assessment score. Its theoretical benefit over preexisting scores is its evaluation of brainstem reflexes and respiratory pattern which may allow better assessment of patients with severe neurologic impairment. OBJECTIVE: Our goal was to perform a scoping systematic review on the available literature for FOUR score and outcome prediction in critically ill patients. The primary outcome of interest was patient global outcome, as assessed by any of: mortality, modified Rankin Score, Glasgow Outcome Score, or any other functional or neuropsychiatric outcome...
November 8, 2018: Neurocritical Care
Charlie Demené, David Maresca, Matthias Kohlhauer, Fanny Lidouren, Philippe Micheau, Bijan Ghaleh, Mathieu Pernot, Renaud Tissier, Mickaël Tanter
Patient mortality at one year reaches 90% after out-of-hospital cardiac arrest and resuscitation. Temperature management is one of the main strategies proposed to improve patient outcome after resuscitation and preclinical studies have shown neuroprotective effects when hypothermia is achieved rapidly, although the underlying mechanisms have not yet been elucidated. State-of-the-art brain imaging technologies can bring new insights into the early cerebral events taking place post cardiac arrest and resuscitation...
November 6, 2018: Scientific Reports
Jessica S Wallisch, Keri Janesko-Feldman, Henry Alexander, Ruchira M Jha, George W Farr, Paul R McGuirk, Anthony E Kline, Travis C Jackson, Marc F Pelletier, Robert S B Clark, Patrick M Kochanek, Mioara D Manole
BACKGROUND: Cerebral edema after cardiac arrest (CA) is associated with increased mortality and unfavorable outcome in children and adults. Aquaporin-4 mediates cerebral water movement and its absence in models of ischemia improves outcome. We investigated early and selective pharmacologic inhibition of aquaporin-4 in a clinically relevant asphyxial CA model in immature rats in a threshold CA insult that produces primarily cytotoxic edema in the absence of blood-brain barrier permeability...
October 26, 2018: Pediatric Research
Jiefeng Xu, Qijiang Chen, Xiaohong Jin, Chunshuang Wu, Zilong Li, Guangju Zhou, Yongan Xu, Anyu Qian, Yulin Li, Mao Zhang
Rapid induction of hypothermia early after resuscitation can be an effective strategy against post-cardiac arrest syndrome (PCAS). Preliminary data suggested that continuous renal replacement therapy (CRRT) might be an efficient method to rapidly induce hypothermia. In this study, we investigated the efficacy of cooling induced by CRRT and its effects on the outcomes of PCAS in a porcine model.Thirty-two male domestic pigs weighing 36 ± 2 kg were randomized into 4 groups: sham control (n = 5), normothermia (n = 9), surface cooling (SC, n = 9), and CRRT (n = 9)...
October 17, 2018: Shock
Lei Huang, Richard L Applegate, Patricia M Applegate, Warren Boling, John H Zhang
Cardiogenic global brain hypoxia-ischemia is a devastating medical problem that is associated with unfavorable neurologic outcomes. Low dose hydrogen gas (up to 2.9%) has been shown to be neuroprotective in a variety of brain diseases. In the present study, we investigated the protective effect of water by electrolysis-derived high concentration hydrogen gas (60%) in a rat model of asphyxia induced-cardiac arrest and global brain hypoxia-ischemia. High concentration hydrogen gas was either administered starting 1 hour prior to cardiac arrest for 1 hour and starting 1 hour post-resuscitation for 1 hour (pre- & post-treatment) or starting 1 hour post-resuscitation for 2 hours (post-treatment)...
July 2018: Medical Gas Research
Daniel Kondziella, Anne Marie Jensen, Thomas Hjuler, Michael Bille, Jesper Kjaergaard
Background: Non-invasive, easy-to-use bedside tools to estimate prognosis in unresponsive patients with postanoxic brain injury are needed. We assessed the usefulness of otoacoustic emissions as outcome markers after cardiac arrest. Methods: Distortion product otoacoustic emissions (DPOAE) and transient evoked otoacoustic emissions (TEOAE) were measured in cardiac arrest patients whose prognosis was deemed to be poor following standard neurological assessment ( n = 10). Ten patients with myocardial infarction without prior loss of consciousness served as controls...
2018: Frontiers in Neurology
Yangyang Zou, Limin Chen, Tianfeng Hua, Min Yang
OBJECTIVE: To investigate the protective function of endovascular cooling method on post-resuscitation syndrome (PRS) in porcine cardiac arrest (CA) model and its mechanism. METHODS: Ventricular fibrillation (VF) was electrically induced and untreated for 8 minutes in 15 healthy male porcines, cardiopulmonary resuscitation (CPR) was then initiated. All successful recovery animals were randomly divided into two groups by random number table. In normal temperature group, the core temperature was maintained at (38...
September 2018: Zhonghua Wei Zhong Bing Ji Jiu Yi Xue
Amy C Walker, Nicholas J Johnson
The post-cardiac arrest syndrome is a highly inflammatory state characterized by organ dysfunction, systemic ischemia and reperfusion injury, and persistent precipitating pathology. Early critical care should focus on identifying and treating arrest etiology and minimizing further injury to the brain and other organs by optimizing perfusion, oxygenation, ventilation, and temperature. Patients should be treated with targeted temperature management, although the exact temperature goal is not clear. No earlier than 72 hours after rewarming, prognostication using a multimodal approach should inform discussions with families regarding likely neurologic outcome...
August 2018: Cardiology Clinics
J Moya Sánchez, M Royo-Villanova Reparaz, A Andreu Ruiz, T Ros Argente Del Castillo, S Sánchez Cámara, J H de Gea García, E Andreu Soler, D Pérez Martínez, M P Olmo Sánchez, C Llamas Lázaro, R H Reyes Marlés, R Jara Rubio
OBJECTIVE: To evaluate the feasibility of using the Sentinella® portable gamma-camera for the diagnosis of brain death (BD). DESIGN: A prospective, observational feasibility study was carried out. SETTING: Intensive Care Unit of a third level hospital. PATIENTS: Consecutive recording was made of the adults diagnosed with brain death based on clinical criteria following admission to the Intensive Care Unit in the period from January to December 2017...
September 27, 2018: Medicina Intensiva
Eva Slapnik, Martin Rauber, Spela Tadel Kocjancic, Anja Jazbec, Marko Noc, Peter Radsel
AIM: Only up to 20% of patients with out-of-hospital cardiac arrest (OHCA) receive immediate and optimal initial cardiac resuscitation and consequently regain consciousness soon after return of spontaneous circulation (ROSC). In the present study, we compared the outcome of conscious survivors of OHCA presenting with ST-elevation myocardial infarction (STEMI) in post-resuscitation electrocardiogram undergoing immediate invasive coronary strategy with randomly selected STEMI patients without preceding OHCA undergoing primary PCI...
December 2018: Resuscitation
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