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Post-cardiac arrest brain

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...
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...
December 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 min of chest compressions, had return of spontaneous circulation (ROSC) for ≥20 min, and were admitted to the PICU after an OHCA. Modes of death were classified as brain death (BD), withdrawal due to neurologic prognosis (W/D-neuro), withdrawal for refractory circulatory failure (W/D-RCF), and re-arrest without ROSC (RA)...
August 14, 2018: Resuscitation
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