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Post-cardiac arrest brain

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...
September 20, 2018: Resuscitation
Sunil K Nadar, Mohammed Mujtaba, Hafidh Al-Hadi, Muhammed Sadiq, Adil Al-Riyami, Mehar Ali, Hatim Al-Lawati
Objectives: Out-of-hospital cardiac arrests (OHCAs) are a leading cause of death worldwide. However, data regarding the management and outcomes of affected patients are lacking in the Middle East. The current study aimed to present the angiographic findings and outcomes of patients presenting with OHCA in Muscat, Oman. Methods: This retrospective study took place between January 2012 and December 2016 at the Sultan Qaboos University Hospital (SQUH), Muscat, Oman...
May 2018: Sultan Qaboos University Medical Journal
Misun Hwang, Becky J Riggs, Sandra Saade-Lemus, Thierry Agm Huisman
Imaging diagnosis of brain death is performed with either four-vessel cerebral angiography or radionuclide cerebral blood flow studies. Unfortunately, timely performance of either study at a critically ill period is not only cumbersome but not feasible in many cases. We present a case of a 6-month-old male three hours status post-cardiac arrest of unknown etiology who underwent contrast-enhanced ultrasound (CEUS) for diagnosis of near absent perfusion, or near brain death. The patient passed away 30 minutes after the exam and clinical diagnosis of brain death was confirmed...
September 7, 2018: Neuroradiology Journal
Yasuyuki Kakihana, Chinatsu Kamikokuryo, Hiroaki Furubeppu, Yutaro Madokoro, Takahiro Futatsuki, Shotaro Miyamoto, Hiroyuki Haraura, Kousaku Hatanaka, Tomohiro Eguchi, Yasuo Saitoh, Naoki Miura, Hiroaki Suzuki, Yukio Ueda, Tomotsugu Yasuda, Takashi Ito
This study aimed to evaluate the usefulness of near-infrared time-resolved spectroscopy (TRS) for the monitoring of post-resuscitation encephalopathy. Cardiac arrest (CA) was induced in pigs by electrical stimuli; then, return of spontaneous circulation (ROSC) was achieved by direct current. The changes in cerebral oxygenation were analyzed by two methods: (1) the time-independent calculation based on the modified Beer-Lambert law (MBL), and (2) the curve-fitting method based on the photon diffusion theory (DT)...
2018: Advances in Experimental Medicine and Biology
Kui Xu, Michelle A Puchowicz, Joseph C LaManna
Transient global brain ischemia, induced by cardiac arrest and resuscitation, results in reperfusion injury leading to delayed selective neuronal cell loss and post-resuscitation mortality. This study determined the effects of post-resuscitation hypotension and hypothermia on long-term survival following cardiac arrest and resuscitation. The capillary density was also determined. Based on the mean arterial blood pressure (MABP) at 1 h of recovery, the normotension group (MABP 80-120 mmHg) and hypotension group (MABP <80 mmHg) were defined...
2018: Advances in Experimental Medicine and Biology
Min Kyun Na, Wonhee Kim, Tae Ho Lim, Bohyoung Jang, Youngsuk Cho, Kyu-Sun Choi, Hyun-Goo Shin, Chiwon Ahn, Juncheol Lee, Jae Guk Kim
AIMS: This study aimed to evaluate the prognostic accuracy of the gray matter to white matter ratio (GWR) in predicting neurological outcomes in post-cardiac arrest patients treated with target temperature management. DATA SOURCES: We systematically searched MEDLINE and EMBASE (Search date: 09/13/2017). Included studies were those evaluating neurological outcomes using the cerebral performance categories scale. We performed a subgroup analysis based on the location of the measurement...
November 2018: Resuscitation
Geneviève Du Pont-Thibodeau, Michael Fry, Matthew Kirschen, Nicholas S Abend, Rebecca Ichord, Vinay M Nadkarni, Robert Berg, Alexis Topjian
AIM: To determine the timing and modes of death of children admitted to a pediatric critical care unit (PICU) of a tertiary care center after an out-of-hospital cardiac arrest (OHCA). METHODS: This is a retrospective descriptive study at a tertiary care PICU of all consecutive patients <18 years old who received ≥ 1 minute of chest compressions, had return of spontaneous circulation (ROSC) for ≥ 20 minutes, and were admitted to the PICU after an OHCA...
August 14, 2018: Resuscitation
Stephane Legriel, Wulfran Bougouin, Richard Chocron, Frankie Beganton, Lionel Lamhaut, Nadia Aissaoui, Nicolas Deye, Daniel Jost, Armand Mekontso-Dessap, Antoine Vieillard-Baron, Eloi Marijon, Xavier Jouven, Florence Dumas, Alain Cariou
PURPOSE: To explore diagnostic pitfalls and treatment issues in out-of-hospital cardiac arrest of neurological cause (OHCA-NC). METHODS: Retrospective analysis of all consecutive patients from the Paris Sudden Death Expertise Centre (France) registry from May 2011 to September 2015 presenting with a sustained return of spontaneous circulation (ROSC) at hospital admission and a final diagnosis of OHCA-NC. Description of the early diagnostic check-up performed to identify the cause of cardiac arrest...
November 2018: Resuscitation
Dino F Druda, Santosh Gone, Andis Graudins
INTRODUCTION: Pentobarbital (PB) is a euthanasia drug in doses of 2 to 10 grams, causing death within 15-30 minutes. We report a case of recovery from lethal pentobarbital deliberate self-poisoning with confirmatory serum drug concentrations. CASE REPORT: A 45-year-old male purchased 20 grams of PB powder over the Internet. He ingested this powder and then alerted his mother 10 minutes later. She found him unresponsive and commenced cardiopulmonary resuscitation (CPR)...
August 2, 2018: Journal of Medical Toxicology: Official Journal of the American College of Medical Toxicology
Sabrina Oerter, Carola Förster, Michael Bohnert
In many forensic cases, the existence of a traumatic brain injury (TBI) is an essential factor, and the determination of the survival time is nearly as important as the determination of whether or not a trauma exists. Since it is known that glucose uptake increases in injured brain cells in order to perpetuate the neuronal integrity, this study focuses on the pathomechanism of brain glucose supply via sodium/glucose cotransporters 1 and 2 (SGLT1, SGLT2) following traumatization. Human cerebrum tissue of male and female individuals who died following TBI was taken from the contusional and contralateral regions, as well as from individuals deceased due to cardiac arrest (control group)...
August 2, 2018: International Journal of Legal Medicine
Stein Foss, Espen Nordheim, Dag W Sørensen, Torgunn B Syversen, Karsten Midtvedt, Anders Åsberg, Thorleif Dahl, Per A Bakkan, Aksel E Foss, Odd R Geiran, Arnt E Fiane, Pål-Dag Line
Background: Donation after circulatory death (DCD) can increase the pool of available organs for transplantation. This pilot study evaluates the implementation of a controlled DCD (cDCD) protocol using normothermic regional perfusion in Norway. Methods: Patients aged 16 to 60 years that are in coma with documented devastating brain injury in need of mechanical ventilation, who would most likely attain cardiac arrest within 60 minutes after extubation, were eligible...
July 2018: Transplantation Direct
Vera Saldien, Tom Schepens, Katrien Van Loock, Gaelle Vermeersch, Davina Wildemeersch, Viviane Van Hoof, Frank De Belder, Johan Bosmans, Marcel Vercauteren, Tomas Menovsky
BACKGROUND AND OBJECTIVE: Intraoperative rupture of a cerebral aneurysm during neurosurgery can be a devastating event that increases perioperative morbidity and mortality. Rapid ventricular pacing (RVP) is a technique to obtain flow arrest for short periods of time during dissection or rupture of the aneurysm. The objective of this study was to evaluate the neurological and cardiac effects of repetitive periods of RVP during cerebrovascular surgery. METHODS: Data from patients who underwent repetitive RVP during craniotomy for cerebrovascular disorders were retrospectively analyzed from a single-center medical records database (Cegeka Medical Health Care Systems)...
July 17, 2018: World Neurosurgery
Jae Hun Oh, Seung Pill Choi, Jung Hee Wee, Jeong Ho Park
PURPOSE: The density ratio of gray matter (GM) to white matter (WM) on brain computed tomography (CT) (gray-to-white matter ratio, GWR) helps predict the prognosis of comatose patients after cardiac arrest. However, Hounsfield units (HU) are not an absolute value and can change based on imaging parameters and CT scanners. We compared the density of brain GM and WM and the GWR by using images scanned with different types of CT machines. METHOD: 102 patients with normal readings who were scanned using three types of CT scanners were included in the study...
July 9, 2018: American Journal of Emergency Medicine
William A Kofke, Yue Ren, John G Augoustides, Hongzhe Li, Katherine Nathanson, Robert Siman, Qing Cheng Meng, Weiming Bu, Sukanya Yandrawatthana, Guy Kositratna, Cecilia Kim, Joseph E Bavaria
Background: Neuroprotection studies are generally unable to demonstrate efficacy in humans. Our specific hypothesis is that multiple pathophysiologic pathways, of variable importance, contribute to ischemic brain damage. As a corollary to this, we discuss the broad hypothesis that a multifaceted approach will improve the probability of efficacious neuroprotection. But to properly test this hypothesis the nature and importance of the multiple contributing pathways needs elucidation. Our aim is to demonstrate, using functional genomics, in human cardiac surgery procedures associated with cerebral ischemia, that the pathogenesis of perioperative human ischemic brain damage involves the function of multiple variably weighted proteins involving several pathways...
2018: Frontiers in Neurology
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