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Post-cardiac arrest brain

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...
August 4, 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: 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. OBJECTIVE: 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 different cerebrovascular disorders were retrospectively analysed from a single-centre medical records database (Cegeka Medical Health Care Systems)...
July 16, 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
Fangfang Zhu, Xia Zhong, Yi Zhou, Zhiqiang Hou, Haoran Hu, Lining Liang, Jibin Chen, Qianqian Chen, Xianfei Ji, Deya Shang
The present study investigated the effects of nicorandil on cerebral injury following cardiopulmonary resuscitation (CPR) in a swine model of cardiac arrest. CPR was performed on swine following 4 min induced ventricular fibrillation. Surviving animals were randomly divided into 3 groups: A nicorandil group (n=8), a control group (n=8) and a sham group (n=4). The sham group underwent the same surgical procedure to imitate cardiac arrest, but ventricular fibrillation was not induced. When the earliest observable return of spontaneous circulation (ROSC) was detected, the nicorandil and control groups received injections of nicorandil and saline, respectively...
July 2018: Experimental and Therapeutic Medicine
Ruimin Wang, Yan Dong, Yujiao Lu, Wenli Zhang, Darrell W Brann, Quanguang Zhang
Hypothermia is currently the only approved therapy for global cerebral ischemia (GCI) after cardiac arrest; however, it unfortunately has multiple adverse effects. As a noninvasive procedure, photobiomodulation (PBM) therapy has emerged as a potential novel treatment for brain injury. PBM involves the use of low-level laser light therapy to influence cell behavior. In this study, we evaluated the therapeutic effects of PBM treatment with an 808-nm diode laser initiated 6 h after GCI. It was noted that PBM dose-dependently protected against GCI-induced neuronal death in the vulnerable hippocampal CA1 subregion...
June 27, 2018: Molecular Neurobiology
Kristin F Phillips, Laxmikant S Deshpande, Robert J DeLorenzo
Status Epilepticus (SE) is a major neurological emergency and is considered a leading cause of Acquired Epilepsy (AE). We have shown that SE produces neuronal injury and prolonged alterations in hippocampal calcium levels ([Ca2+ ]i ) that may underlie the development of AE. Interventions preventing the SE-induced Ca2+ plateau could therefore prove to be beneficial in lowering the development of AE after SE. Hypothermia is used clinically to prevent neurological complications associated with Traumatic Brain Injury, cardiac arrest, and stroke...
2018: Frontiers in Neurology
Niel Chen, Clifton W Callaway, Francis X Guyette, Jon C Rittenberger, Ankur A Doshi, Cameron Dezfulian, Jonathan Elmer
INTRODUCTION: Cardiac arrest etiology is often assigned according to the Utstein template, which differentiates medical (formerly "presumed cardiac") from other causes. These categories are poorly defined, contain within them many clinically distinct etiologies, and are rarely based on diagnostic testing. Optimal clinical care and research require more rigorous characterization of arrest etiology. METHODS: We developed a novel system to classify arrest etiology using a structured chart review of consecutive patients treated at a single center after in- or out-of-hospital cardiac arrest over four years...
June 22, 2018: Resuscitation
Michael Ertl, Sarah Weber, Gertrud Hammel, Christoph Schroeder, Christos Krogias
BACKGROUND AND PURPOSE: Early prognostication of the outcome in resuscitated post cardiac arrest (CA) patients remains challenging especially if treated with therapeutic hypothermia. Brain edema caused by hypoxic-ischemic encephalopathy (HIE) can indirectly be estimated by transorbital sonography (TOS) taking in account the optic nerve sheath diameter (ONSD). The prognostic value of this easy, safe, and reproducible technique was investigated in this study. METHODS: A total of 49 patients, initially unconscious (Glasgow Coma Scale ≤6) after successful resuscitation, were enrolled into this prospective observational study...
June 8, 2018: Journal of Neuroimaging: Official Journal of the American Society of Neuroimaging
E Wallin, I-M Larsson, J Nordmark-Grass, I Rosenqvist, M-L Kristofferzon, S Rubertsson
BACKGROUND: Using cerebral oxygen venous saturation post-cardiac arrest (CA) is limited because of a small sample size and prior to establishment of target temperature management (TTM). We aimed to describe variations in jugular bulb oxygen saturation during intensive care in relation to neurological outcome at 6 months post- CA in cases where TTM 33°C was applied. METHOD: Prospective observational study in patients over 18 years, comatose immediately after resuscitation from CA...
May 24, 2018: Acta Anaesthesiologica Scandinavica
Robert F Johnson
Determination and declaration of death by neurologic criteria, brain death, is an established and legally accepted clinical practice with profound implications. Concerns regarding the accuracy of this diagnosis raise important clinical, ethical, and legal issues. A recent magazine article highlights these concerns by describing a poignant example of a patient meeting accepted clinical and ancillary testing criteria for brain death in the setting of post cardiac arrest hypoxic ischemic encephalopathy (CA-HIE)...
January 1, 2018: American Journal of Hospice & Palliative Care
Qihong Wang, Peng Miao, Hiren R Modi, Sahithi Garikapati, Raymond C Koehler, Nitish V Thakor
Laboratory and clinical studies have demonstrated that therapeutic hypothermia (TH), when applied as soon as possible after resuscitation from cardiac arrest (CA), results in better neurological outcome. This study tested the hypothesis that TH would promote cerebral blood flow (CBF) restoration and its maintenance after return of spontaneous circulation (ROSC) from CA. Twelve Wistar rats resuscitated from 7-min asphyxial CA were randomized into two groups: hypothermia group (7 H, n = 6), treated with mild TH (33-34℃) immediately after ROSC and normothermia group (7 N, n = 6,37...
January 1, 2018: Journal of Cerebral Blood Flow and Metabolism
Daniel P Fudulu, Ben Gibbison, Thomas Upton, Serban C Stoica, Massimo Caputo, Stafford Lightman, Gianni D Angelini
Background: Corticosteroids have been administered prophylactically for more than 60 years in pediatric heart surgery, however, their use remains a matter of debate. There are three main indications for corticosteroid use in pediatric heart surgery with the use of cardiopulmonary bypass (CPB): (1) to blunt the systemic inflammatory response (SIRS) induced by the extracorporeal circuit; (2) to provide perioperative supplementation for presumed relative adrenal insufficiency; (3) for the presumed neuroprotective effect during deep hypothermic circulatory arrest operations...
2018: Frontiers in Pediatrics
Mitsuaki Nishikimi, Takayuki Ogura, Kota Matsui, Kunihiko Takahashi, Kenji Fukaya, Keibun Liu, Hideo Morita, Mitsunobu Nakamura, Shigeyuki Matsui, Naoyuki Matsuda
Background: Early brain CT is one of the most useful tools for estimating the prognosis in patients with post-cardiac arrest syndrome (PCAS) at the emergency department (ED). The aim of this study was to evaluate the prognosis-prediction accuracy of the emergency physicians' interpretation of the findings on early brain CT in PCAS patients treated by targeted temperature management (TTM). Methods: This was a double-center, retrospective, observational study. Eligible subjects were cardiac arrest patients admitted to the intensive care unit (ICU) for TTM between April 2011 and March 2017...
2018: Journal of Intensive Care
Anne Brücken, Christian Bleilevens, Philipp Berger, Kay Nolte, Nadine T Gaisa, Rolf Rossaint, Gernot Marx, Matthias Derwall, Michael Fries
Guidelines endorse targeted temperature management to reduce neurological sequelae and mortality after cardiac arrest (CA). Additional therapeutic approaches are lacking. Inhaled nitric oxide (iNO) given post systemic ischemia/reperfusion injury improves outcomes. Attenuated inflammation by iNO might be crucial in brain protection. iNO augmented mild therapeutic hypothermia (MTH) may improve outcome after CA exceeding the effect of MTH alone. Following ten minutes of CA and three minutes of cardiopulmonary resuscitation, 20 male Sprague-Dawley rats were randomized to receive MTH at 33 °C for 6hrs or MTH + 20ppm iNO for 5hrs; one group served as normothermic control...
April 30, 2018: Scientific Reports
Abhipradnya Bipin Wahul, Pranav Chintamani Joshi, Arvind Kumar, Sumana Chakravarty
Despite the advancements in medical sciences in last few decades, we are yet to develop promising therapeutics for stroke, which is one of the current global non-communicative disease concerns. The occurrence of stroke is likely to increase further due to the transition in our lifestyles. Inadequate knowledge of the sequential region-specific pathological events induced by cerebral ischemia is one of the underlying reasons. Hence to address this, we have used Bilateral Common Carotid Arterial occlusion (BCCAo) model that mimics human cardiac arrest condition...
April 24, 2018: Journal of Chemical Neuroanatomy
Mitsuaki Nishikimi, Takayuki Ogura, Kazuki Nishida, Kunihiko Takahashi, Kenji Fukaya, Keibun Liu, Mitsunobu Nakamura, Shigeyuki Matsui, Naoyuki Matsuda
INTRODUCTION: The aim of this study was to evaluate the differential effects of mild therapeutic hypothermia (MTH) in post-cardiac arrest syndrome (PCAS) patients depending on the presence/absence of hypoxic encephalopathy (HE) in the early brain CT images obtained before the initiation of MTH. METHODS: We conducted a retrospective review of the data of a total of 129 patients with PCAS who were treated by MTH (34 °C) or normothermia treatment (NT) (35 °C or 36 °C), and had undergone brain CT examination prior to the initiation of these treatments...
July 2018: Resuscitation
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