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Post cardiac arrest encephalopathy

Roland Renzel, Christian R Baumann, Ian Mothersill, Rositsa Poryazova
OBJECTIVES: Electroencephalography (EEG) is one of the methods used in predicting the outcome after cerebral hypoxia. In this study we aim to evaluate the significance of generalized periodic discharges (GPD) as a prognostic marker. METHODS: We retrospectively analyzed the medical histories of patients, who underwent an EEG after cardiac arrest during the time period from 2005 to 2013 at the University Hospital Zurich. All EEGs were re-interpreted using the 2012 American Clinical Neurophysiology Society (ACNS) classification for intensive care unit (ICU) EEGs...
January 2017: Clinical Neurophysiology: Official Journal of the International Federation of Clinical Neurophysiology
Kacey B Anderson, Samuel M Poloyac, Patrick M Kochanek, Philip E Empey
Targeted temperature management (TTM) has been shown to reduce mortality and improve neurological outcomes in out-of-hospital cardiac arrest (CA) patients and in neonates with hypoxic-ischemic encephalopathy (HIE). TTM has also been associated with adverse drug events in the critically ill patient due to its effect on drug pharmacokinetics (PKs) and pharmacodynamics (PDs). We aim to evaluate the current literature on the effect of TTM on drug PKs and PDs following CA. MEDLINE/PubMed databases were searched for publications, which include the MeSH terms hypothermia, drug metabolism, drug transport, P450, critical care, cardiac arrest, hypoxic-ischemic encephalopathy, pharmacokinetics, and pharmacodynamics between July 2006 and October 2015...
December 2016: Therapeutic Hypothermia and Temperature Management
Pieternel Vanherpe, Maarten Schrooten
For the diagnosis of electrographic seizures or status epilepticus, we reduced the number of EEG-electrodes to make urgent EEG monitoring more feasible. Unlike the current existing research, with mixed results, we studied a specific population with postanoxic brain damage, expecting a higher yield of detection of ictal EEG patterns. In a population treated with therapeutic hypothermia post-cardiac arrest, the initial EEGs were reformatted in a longitudinal, a hairline and an 8-lead montage, and independently reviewed by two investigators...
July 1, 2016: Acta Neurologica Belgica
(no author information available yet)
No abstract text is available yet for this article.
June 2016: Annals of Intensive Care
Marta Lamartine Monteiro, Fabio Silvio Taccone, Chantal Depondt, Irene Lamanna, Nicolas Gaspard, Noémie Ligot, Nicolas Mavroudakis, Gilles Naeije, Jean-Louis Vincent, Benjamin Legros
BACKGROUND: The aim of this study was to evaluate the prognostic value of continuous electroencephalogram (cEEG) during the first 48 h following cardiac arrest (CA) in patients treated with targeted temperature management (TTM). METHODS: We reviewed data from 92 comatose post-CA patients over a 6 year-period; cEEG recordings were performed during TTM and restoration of normothermia. EEG findings were divided into four time-periods: 0-8, 8-16, 16-24, and 24-48 h after CA...
April 2016: Neurocritical Care
Saurabh Saigal, Jai Prakash Sharma, Ritika Dhurwe, Sanjay Kumar, Mohan Gurjar
Targeted temperature management (TTM) in today's modern era, especially in intensive care units represents a promising multifaceted therapy for a variety of conditions. Though hypothermia is being used since Hippocratic era, the renewed interest of late has been since early 21(st) century. There have been multiple advancements in this field and varieties of cooling devices are available at present. TTM requires careful titration of its depth, duration and rewarming as it is associated with side-effects. The purpose of this review is to find out the best evidence-based clinical practice criteria of therapeutic hypothermia in critical care settings...
September 2015: Indian Journal of Critical Care Medicine
Yu V Zarzhetskii, M Sh Avrushchenko, V V Moroz, T A Gudasheva, S B Seredenin
Neurological status was assessed and the numbers of neurons per 1 mm in pyramidal neuronal layer length in CA1 and CA4 hippocampal fields and cerebellar Purkinje cells were evaluated in albino male rats on post-resuscitation day 14 after 12-min cardiac arrest. Intraperitoneal administration of GK-2 (1 mg/kg 30 min after resuscitation and within the next 3 days with an interval of 24 h) accelerated neurological recovery of the animals, sharply reduced the intensity of cerebellar Purkinje cell death, and prevented loss of pyramidal neurons in the hippocampus...
August 2015: Bulletin of Experimental Biology and Medicine
John McGinniss, Peter Marshall, Shyoko Honiden
Targeted temperature management has an established role in treating the post-cardiac arrest syndrome after out-of-hospital cardiac arrest with an initial rhythm of ventricular tachycardia/ventricular fibrillation. There is less certain benefit if the initial rhythm is pulseless electrical activity/asystole or for in-hospital cardiac arrest. Targeted temperature management may have a role as salvage modality for conditions causing intracranial hypertension, such as traumatic brain injury, hepatic encephalopathy, intracerebral hemorrhage, and acute stroke...
September 2015: Clinics in Chest Medicine
Nicolas Mongardon, Guillaume Geri, Nicolas Deye, Romain Sonneville, Florence Boissier, Sébastien Perbet, Laurent Camous, Virginie Lemiale, Marina Thirion, Armelle Mathonnet, Laurent Argaud, Laurent Bodson, Stéphane Gaudry, Antoine Kimmoun, Stéphane Legriel, Nicolas Lerolle, David Luis, Charles-Edouard Luyt, Julien Mayaux, Bertrand Guidet, Frédéric Pène, Jean-Paul Mira, Alain Cariou
BACKGROUND: Compared to many other cardiovascular diseases, there is a paucity of data on the characteristics of successfully resuscitated cardiac arrest (CA) patients with human immunodeficiency virus (HIV) infection. We investigated causes, clinical features and outcome of these patients, and assessed the specific burden of HIV on outcome. METHODS: Retrospective analysis of HIV-infected patients admitted to 20 French ICUs for successfully resuscitated CA (2000-2012)...
December 15, 2015: International Journal of Cardiology
Aparna Dalal
Patients with end stage liver disease (ESLD) have complex problems such as cirrhotic cardiomyopathy, coronary artery disease, hepatopulmonary syndrome (HPS), portopulmonary hypertension (POPH), hepatic encephalopathy, intracranial hypertension, (ICP), left ventricular outflow tract obstruction (LVOTO), high Model of end liver disease (MELD) scores, hyponatremia, and coagulopathies. The anesthesia management for liver transplantation can be very complex, dynamic and challenging. Anesthesia agents affect hepatic blood flow and anesthetic drug distribution, metabolism and elimination maybe altered in end stage liver disease...
January 2016: Transplantation Reviews
Arthur J Siegel
Cerebral edema due to exercise-associated hyponatremia and cardiac arrest due to atherosclerotic heart disease cause rare marathon-related fatalities in young female and middle-aged male runners, respectively. Studies in asymptomatic middle-aged male physician-runners during races identified inflammation due to skeletal muscle injury after glycogen depletion as the shared underlying cause. Nonosmotic secretion of arginine vasopressin as a neuroendocrine stress response to rhabdomyolysis mediates hyponatremia as a variant of the syndrome of inappropriate antidiuretic hormone secretion...
October 2015: American Journal of Medicine
Brian W Roberts, Paul Karagiannis, Michael Coletta, J Hope Kilgannon, Michael E Chansky, Stephen Trzeciak
OBJECTIVE: Partial pressure of arterial carbon dioxide (PaCO2) is a major regulator of cerebral blood flow (CBF). Derangements in PaCO2 have been thought to worsen clinical outcomes after many forms of cerebral injury by altering CBF. Our aim was to systematically analyze the biomedical literature to determine the effects of PaCO2 derangements on clinical outcomes after cerebral injury. METHODS: We performed a search of Cochrane Library, PUBMED, CINHAL, conference proceedings, and other sources using a comprehensive strategy...
June 2015: Resuscitation
J Zhang, Q Li, Z Zhang, X Sun
The authors report an unusual case of diffuse subarachnoid hemorrhage on brain computed tomography (CT) scan in a patient with post-resuscitation anoxic encephalopathy. A 42-year-old woman suffered both respiratory and cardiac arrest, associated with hypoxic encephalopathy, which occurred during a visit to our gynecology clinic. CT examination was performed the next day, which revealed a hyperdensity in the basal cisterns with a diffuse cerebral edema. Lumbar puncture was applied for diagnosis. No yellow coloration or red cells were observed in the cerebrospinal fluid...
February 2015: Neuro-Chirurgie
Robert Kowalik, Ewa Szczerba, Łukasz Kołtowski, Marcin Grabowski, Karolina Chojnacka, Wojciech Golecki, Adam Hołubek, Grzegorz Opolski
BACKGROUND: Hypoxic-ischaemic encephalopathy is the main determinant of clinical outcome after cardiac arrest. The study was designed to determine long-term neurological and psychological status in cardiac arrest survivors, as well as to compare neuropsychological outcomes between patients treated with mild therapeutic hypothermia (MTH) and patients who did not undergo hypothermia treatment. METHODS: The article describes a single-center, retrospective, observational study on 28 post-cardiac arrest adult patients treated in the cardiac intensive care unit who qualified for MTH vs...
2014: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
Yong Hwan Kim, Jun Ho Lee, Chong Kun Hong, Kwang Won Cho, Jung Hoon Yeo, Mun Ju Kang, Yang Weon Kim, Kyoung Yul Lee, Jin Joo Kim, Seong Youn Hwang
OBJECTIVES: Few parameters are available to predict neurologic outcome of post-cardiac arrest patients in the early stage of treatment. Optic nerve sheath diameter (ONSD) has been used to indirectly assess intracranial pressure. This study evaluated whether ONSD, an additional parameter in initial brain computed tomography (CT) scans, can be an early predictor of neurologic outcome in post-cardiac arrest patients. METHODS: A total of 112 cardiac arrest patients between November 2012 and October 2013 were identified...
October 2014: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
Ted L Rothstein
Rational medical management of patients who remain comatose following cardio-pulmonary resuscitation (CPR) due to anoxic-ischemic encephalopathy depends upon the early identification of those with a hopeless prognosis - regardless of how aggressively they are managed. Conversely, it is mandatory that we recognize those patients with the potential to recover in order to institute aggressive therapeutic measures. The bilateral absence of the N20 Cortical Somatosensory Evoked Potential has been identified as the most reliable predictor of an unfavorable prognosis in normothermic patients...
November 2014: Clinical Neurology and Neurosurgery
Martijn Beudel, Marleen C Tjepkema-Cloostermans, Jochem H Boersma, Michel J A M van Putten
Post-anoxic encephalopathy (PAE) has a heterogenous outcome which is difficult to predict. At present, it is possible to predict poor outcome using somatosensory evoked potentials in only a minority of the patients at an early stage. In addition, it remains difficult to predict good outcome at an early stage. Network architecture, as can be quantified with continuous electroencephalography (cEEG), may serve as a candidate measure for predicting neurological outcome. Here, we explore whether cEEG monitoring can be used to detect the integrity of neural network architecture in patients with PAE after cardiac arrest...
2014: Frontiers in Neurology
Gerhard Bauer, Eugen Trinka, Peter W Kaplan
In patients with coma resulting from hypoxic encephalopathy (e.g., after cardiac arrest), the EEG may reflect the severity of brain dysfunction, although the exact relationship among the EEG changes, the extent of neuronal damage, and consequent prognosis is still under study. Many prognostications are based on particular EEG patterns at a time point, such as burst suppression or generalized periodic discharges, but with sequential, repeated, or with prolonged or continuous EEG monitoring, it has become increasingly clear that more information might be gleaned from EEG pattern changes over time...
October 2013: Journal of Clinical Neurophysiology: Official Publication of the American Electroencephalographic Society
Alexis A Topjian, Maryam Y Naim, Vinay Nadkarni
Therapeutic hypothermia following cardiac arrest improves neurologic outcome following adult ventricular fibrillation (VF) cardiac arrest and perinatal hypoxic ischemic encephalopathy. Evaluation of therapeutic hypothermia in the pediatric cardiac arrest population has been limited thus far to retrospective evaluations and to date there have been no published prospective efficacy trials. Two retrospective pediatric cohort studies showed no benefit from hypothermia compared to usual care. The timing (intra-arrest or post-arrest) and duration of hypothermia may impact patient outcome...
January 1, 2012: World Journal for Pediatric & Congenital Heart Surgery
Kaitlen Howell, Eva Grill, Anke-Maria Klein, Andreas Straube, Andreas Bender
OBJECTIVES: To examine the natural clinical course of patients admitted to inpatient neurorehabilitation in a coma, vegetative state (VS), or minimally conscious state (MCS) after anoxic-ischaemic encephalopathy (AIE). METHODS: This is a retrospective cohort study of 113 consecutive patients admitted to a German inpatient neurorehabilitation centre with severe disorders of consciousness (DOC) following AIE due to cardiac arrest over a 6-year period. Functional independence was measured with the Glasgow Outcome Scale (GOS) and recovery of consciousness with the Coma Remission Scale (CRS)...
October 2013: Resuscitation
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