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Giannino G, Nocera L, Andolfatto M, Braia V, Giacobbe F, Bruno F, Saglietto A, Angelini F, De Filippo O, D'Ascenzo F, De Ferrari GM, Dusi V. Vagal nerve stimulation in myocardial ischemia/reperfusion injury: from bench to bedside. Bioelectron Med 2024; 10:22. [PMID: 39267134 PMCID: PMC11395864 DOI: 10.1186/s42234-024-00153-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2024] [Accepted: 07/31/2024] [Indexed: 09/14/2024] Open
Abstract
The identification of acute cardioprotective strategies against myocardial ischemia/reperfusion (I/R) injury that can be applied in the catheterization room is currently an unmet clinical need and several interventions evaluated in the past at the pre-clinical level have failed in translation. Autonomic imbalance, sustained by an abnormal afferent signalling, is a key component of I/R injury. Accordingly, there is a strong rationale for neuromodulation strategies, aimed at reducing sympathetic activity and/or increasing vagal tone, in this setting. In this review we focus on cervical vagal nerve stimulation (cVNS) and on transcutaneous auricular vagus nerve stimulation (taVNS); the latest has the potential to overcome several of the issues of invasive cVNS, including the possibility of being used in an acute setting, while retaining its beneficial effects. First, we discuss the pathophysiology of I/R injury, that is mostly a consequence of the overproduction of reactive oxygen species. Second, we describe the functional anatomy of the parasympathetic branch of the autonomic nervous system and the most relevant principles of bioelectronic medicine applied to electrical vagal modulation, with a particular focus on taVNS. Then, we provide a detailed and comprehensive summary of the most relevant pre-clinical studies of invasive and non-invasive VNS that support its strong cardioprotective effect whenever there is an acute or chronic cardiac injury and specifically in the setting of myocardial I/R injury. The potential benefit in the emerging field of post cardiac arrest syndrome (PCAS) is also mentioned. Indeed, electrical cVNS has a strong anti-adrenergic, anti-inflammatory, antioxidants, anti-apoptotic and pro-angiogenic effect; most of the involved molecular pathways were already directly confirmed to take place at the cardiac level for taVNS. Pre-clinical data clearly show that the sooner VNS is applied, the better the outcome, with the possibility of a marked infarct size reduction and almost complete left ventricular reverse remodelling when VNS is applied immediately before and during reperfusion. Finally, we describe in detail the limited but very promising clinical experience of taVNS in I/R injury available so far.
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Affiliation(s)
- Giuseppe Giannino
- Cardiology, Department of Medical Sciences, University of Turin, Torino, Italy
- Division of Cardiology, Cardiovascular and Thoracic Department, 'Città della Salute e della Scienza' Hospital, Corso Bramante 88, Turin, 10126, Italy
| | - Lorenzo Nocera
- Cardiology, Department of Medical Sciences, University of Turin, Torino, Italy
- Division of Cardiology, Cardiovascular and Thoracic Department, 'Città della Salute e della Scienza' Hospital, Corso Bramante 88, Turin, 10126, Italy
| | - Maria Andolfatto
- Cardiology, Department of Medical Sciences, University of Turin, Torino, Italy
- Division of Cardiology, Cardiovascular and Thoracic Department, 'Città della Salute e della Scienza' Hospital, Corso Bramante 88, Turin, 10126, Italy
| | - Valentina Braia
- Cardiology, Department of Medical Sciences, University of Turin, Torino, Italy
- Division of Cardiology, Cardiovascular and Thoracic Department, 'Città della Salute e della Scienza' Hospital, Corso Bramante 88, Turin, 10126, Italy
| | - Federico Giacobbe
- Cardiology, Department of Medical Sciences, University of Turin, Torino, Italy
- Division of Cardiology, Cardiovascular and Thoracic Department, 'Città della Salute e della Scienza' Hospital, Corso Bramante 88, Turin, 10126, Italy
| | - Francesco Bruno
- Cardiology, Department of Medical Sciences, University of Turin, Torino, Italy
| | - Andrea Saglietto
- Cardiology, Department of Medical Sciences, University of Turin, Torino, Italy
| | - Filippo Angelini
- Cardiology, Department of Medical Sciences, University of Turin, Torino, Italy
| | - Ovidio De Filippo
- Cardiology, Department of Medical Sciences, University of Turin, Torino, Italy
| | - Fabrizio D'Ascenzo
- Cardiology, Department of Medical Sciences, University of Turin, Torino, Italy
- Division of Cardiology, Cardiovascular and Thoracic Department, 'Città della Salute e della Scienza' Hospital, Corso Bramante 88, Turin, 10126, Italy
| | - Gaetano Maria De Ferrari
- Cardiology, Department of Medical Sciences, University of Turin, Torino, Italy
- Division of Cardiology, Cardiovascular and Thoracic Department, 'Città della Salute e della Scienza' Hospital, Corso Bramante 88, Turin, 10126, Italy
| | - Veronica Dusi
- Cardiology, Department of Medical Sciences, University of Turin, Torino, Italy.
- Division of Cardiology, Cardiovascular and Thoracic Department, 'Città della Salute e della Scienza' Hospital, Corso Bramante 88, Turin, 10126, Italy.
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Vos I, Lucassen F, Bens B, Dercksen B, Postma R, Jorna E, ter Maaten J, Struys M, ter Avest E. Pre-hospital care after return of spontaneous circulation: Are we achieving our targets? Resusc Plus 2024; 19:100691. [PMID: 39006133 PMCID: PMC11246053 DOI: 10.1016/j.resplu.2024.100691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2024] [Accepted: 06/01/2024] [Indexed: 07/16/2024] Open
Abstract
Background Early restoration of normal physiology when return of spontaneous circulation (ROSC) is obtained after an out-of-hospital cardiac arrest (OHCA) reduces the risk of developing post-cardiac arrest syndrome (PCAS). This study aims to investigate if (and to which extent) this can be achieved within the scope of practice of standard emergency medical services (EMS) crews. Methods A prospective mixed-methods quantitative and qualitative cohort study was performed including adult patients with a non-traumatic OHCA presented to a university hospital emergency department (ED) in the Netherlands after pre-hospital ROSC was obtained. Primary endpoint was the percentage of patients with deranged physiology post-ROSC in whom EMS crews were able to reach recommended treatment targets. Results During a 32-month period, 160 patients presenting with ROSC after OHCA were included. Median (IQR) pre-hospital treatment duration was 40 (34-51) minutes. When deranged physiology was present (n = 133), it could be restored by EMS crews in 29% of the patients. Although average etCO2 and SpO2 improved gradually over time during pre-hospital treatment, recommended treatment targets could not be achieved in respectively 55% (30/55) and 43% (20/46) of the patients. Similarly, airway problems (24/46, 52%), hypotension (20/23, 87%) and post-anoxic agitation (16/43, 37%) could often not be resolved by EMS crews. The ability to restore normal physiology by EMS could not be predicted based on patient characteristics or in-arrest variables. Conclusion Deranged physiology after an OHCA is commonly encountered, and often difficult to treat within the scope of practice of regular EMS crews. Involvement of advanced critical care teams with a wider scope of practice at an early stage may contribute to a better outcome for these patients.
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Affiliation(s)
- I.A. Vos
- Department of Acute Care, University Medical Centre Groningen, University of Groningen, The Netherlands
| | - F.G. Lucassen
- Department of Acute Care, University Medical Centre Groningen, University of Groningen, The Netherlands
- Department of Emergency Medicine, Isala Medical Centre Zwolle, The Netherlands
| | - B.W.J. Bens
- Department of Acute Care, University Medical Centre Groningen, University of Groningen, The Netherlands
| | - B. Dercksen
- Department of Anaesthesiology, University Medical Centre Groningen, University of Groningen, The Netherlands
- Lifeliner 4, Groningen Airport Eelde, University Medical Centre Groningen, The Netherlands
- UMCG Ambulancezorg, Tynaarlo, Drenthe, The Netherlands
| | - R. Postma
- Department of Anaesthesiology, University Medical Centre Groningen, University of Groningen, The Netherlands
- Ambulancezorg Groningen, Groningen, The Netherlands
| | - E.M.F. Jorna
- Kijlstra Ambulancezorg, Drachten, Friesland, The Netherlands
| | - J.C. ter Maaten
- Department of Acute Care, University Medical Centre Groningen, University of Groningen, The Netherlands
- Department of Internal Medicine, University Medical Centre Groningen, University of Groningen, The Netherlands
| | - M.M.R.F. Struys
- Department of Anaesthesiology, University Medical Centre Groningen, University of Groningen, The Netherlands
| | - E. ter Avest
- Department of Acute Care, University Medical Centre Groningen, University of Groningen, The Netherlands
- London’s Air Ambulance Charity, London, United Kingdom
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Obling LER, Beske RP, Meyer MAS, Grand J, Wiberg S, Damm-Hejmdal A, Bjerre M, Frikke-Schmidt R, Folke F, Møller JE, Kjaergaard J, Hassager C. Inflammatory response after prehospital high-dose glucocorticoid to patients resuscitated from out-of-hospital cardiac arrest: A sub-study of the STEROHCA trial. Resuscitation 2024; 202:110340. [PMID: 39094677 DOI: 10.1016/j.resuscitation.2024.110340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Revised: 07/24/2024] [Accepted: 07/25/2024] [Indexed: 08/04/2024]
Abstract
BACKGROUND The post-cardiac arrest syndrome (PCAS) after out-of-hospital cardiac arrest (OHCA) is characterized by a series of pathological events, including inflammation. In the randomized "STERoid for OHCA" (STEROHCA) trial, prehospital high-dose glucocorticoid decreased interleukin (IL) 6 and C-reactive protein levels following resuscitated OHCA. The aim of this predefined sub-study was to assess the inflammatory response the first three days of admission. METHODS The STEROHCA trial enrolled 137 OHCA patients randomized to either a single prehospital injection of methylprednisolone 250 mg or placebo. Inflammatory markers, including pro- and anti-inflammatory cytokines, were analyzed in plasma samples, from 0-, 24-, 48-, and 72 h post-admission. Mixed-model analyses were applied using log-transformed data to assess group differences. RESULTS The 137 patients included in this sub-study had a median age of 67 years (57 to 74), and the 180-day survival rates were 75% (n = 51/68) and 64% (n = 44/69) in the glucocorticoid and placebo group, respectively. A total of 130 (95%) patients had at least one plasma sample available. The anti-inflammatory cytokine IL-10 was increased at hospital admission in the glucocorticoid group (ratio 2.74 (1.49-5.05), p = 0.006), but the intervention showed the strongest effect after 24 h, decreasing pro-inflammatory levels of IL-6 (ratio 0.06 (0.03-0.10), p < 0.001), IL-8 (ratio 0.53 (0.38-0.75), p < 0.001), macrophage chemokine protein-1 (MCP-1, ratio 0.02 (0.13-0.31), p < 0.001), macrophage inflammatory protein-1-beta (MIP-1b, ratio 0.28 (0.18-0.45), p < 0.001), and tumor necrosis factor-α (TNF-α, ratio 0.6 (0.4-0.8), p = 0.01). CONCLUSION Administering high-dose glucocorticoid treatment promptly after resuscitation from OHCA influenced the inflammatory response with a reduction in several systemic proinflammatory cytokines after 24 h. TRIAL REGISTRATION EudraCT number: 2020-000855-11; submitted March 30, 2020. URL: https://www. CLINICALTRIALS gov; Unique Identifier: NCT04624776.
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Affiliation(s)
- Laust E R Obling
- Department of Cardiology, Rigshospitalet - Copenhagen University Hospital, Copenhagen, Denmark.
| | - Rasmus P Beske
- Department of Cardiology, Rigshospitalet - Copenhagen University Hospital, Copenhagen, Denmark
| | - Martin A S Meyer
- Department of Cardiology, Rigshospitalet - Copenhagen University Hospital, Copenhagen, Denmark
| | - Johannes Grand
- Department of Cardiology, Rigshospitalet - Copenhagen University Hospital, Copenhagen, Denmark
| | - Sebastian Wiberg
- Department of Cardiology, Rigshospitalet - Copenhagen University Hospital, Copenhagen, Denmark; Department of Cardiothoracic Anesthesiology, Rigshospitalet - Copenhagen University Hospital, Copenhagen, Denmark; Department of Clinical Medicine - University of Copenhagen, Copenhagen, Denmark
| | | | - Mette Bjerre
- Department of Clinical Medicine, Medical/Steno Aarhus Research Laboratory - Aarhus University, Aarhus, Denmark
| | - Ruth Frikke-Schmidt
- Department of Clinical Medicine - University of Copenhagen, Copenhagen, Denmark; Department of Clinical Biochemistry, Rigshospitalet - Copenhagen University Hospital, Copenhagen, Denmark
| | - Fredrik Folke
- Department of Clinical Medicine - University of Copenhagen, Copenhagen, Denmark; Emergency Medical Services - Capital Region of Denmark, Copenhagen, Denmark; Department of Cardiology, Herlev-Gentofte Hospital - Copenhagen University Hospital, Copenhagen, Denmark
| | - Jacob E Møller
- Department of Cardiology, Rigshospitalet - Copenhagen University Hospital, Copenhagen, Denmark; Department of Clinical Medicine - University of Copenhagen, Copenhagen, Denmark; Department of Cardiology - Odense University Hospital, Odense, Denmark
| | - Jesper Kjaergaard
- Department of Cardiology, Rigshospitalet - Copenhagen University Hospital, Copenhagen, Denmark; Department of Clinical Medicine - University of Copenhagen, Copenhagen, Denmark
| | - Christian Hassager
- Department of Cardiology, Rigshospitalet - Copenhagen University Hospital, Copenhagen, Denmark; Department of Clinical Medicine - University of Copenhagen, Copenhagen, Denmark
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Hirsch KG, Tamura T, Ristagno G, Sekhon MS. Wolf Creek XVII Part 8: Neuroprotection. Resusc Plus 2024; 17:100556. [PMID: 38328750 PMCID: PMC10847936 DOI: 10.1016/j.resplu.2024.100556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2024] Open
Abstract
Introduction Post-cardiac arrest brain injury (PCABI) is the primary determinant of clinical outcomes for patients who achieve return of spontaneous circulation after cardiac arrest (CA). There are limited neuroprotective therapies available to mitigate the acute pathophysiology of PCABI. Methods Neuroprotection was one of six focus topics for the Wolf Creek XVII Conference held on June 14-17, 2023 in Ann Arbor, Michigan, USA. Conference invitees included international thought leaders and scientists in the field of CA resuscitation from academia and industry. Participants submitted via online survey knowledge gaps, barriers to translation, and research priorities for each focus topic. Expert panels used the survey results and their own perspectives and insights to create and present a preliminary unranked list for each category that was debated, revised and ranked by all attendees to identify the top 5 for each category. Results Top 5 knowledge gaps included developing therapies for neuroprotection; improving understanding of the pathophysiology, mechanisms, and natural history of PCABI; deploying precision medicine approaches; optimizing resuscitation and CPR quality; and determining optimal timing for and duration of interventions. Top 5 barriers to translation included patient heterogeneity; nihilism & lack of knowledge about cardiac arrest; challenges with the translational pipeline; absence of mechanistic biomarkers; and inaccurate neuro-triage and neuroprognostication. Top 5 research priorities focused on translational research and trial optimization; addressing patient heterogeneity and individualized interventions; improving understanding of pathophysiology and mechanisms; developing mechanistic and outcome biomarkers across post-CA time course; and improving implementation of science and technology. Conclusion This overview can serve as a guide to transform the care and outcome of patients with PCABI. Addressing these topics has the potential to improve both research and clinical care in the field of neuroprotection for PCABI.
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Affiliation(s)
- Karen G. Hirsch
- Department of Neurology, Stanford University, Stanford, CA, United States
| | - Tomoyoshi Tamura
- Department of Emergency and Critical Care Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Giuseppe Ristagno
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Mypinder S. Sekhon
- Division of Critical Care Medicine and Department of Medicine, University of British Columbia, Vancouver, Canada
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5
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Obling LER, Beske RP, Meyer MAS, Grand J, Wiberg S, Mohr T, Damm-Hejmdal A, Forman JL, Frikke-Schmidt R, Folke F, Møller JE, Kjaergaard J, Hassager C. Effect of prehospital high-dose glucocorticoid on hemodynamics in patients resuscitated from out-of-hospital cardiac arrest: a sub-study of the STEROHCA trial. Crit Care 2024; 28:28. [PMID: 38254130 PMCID: PMC10801994 DOI: 10.1186/s13054-024-04808-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 01/12/2024] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND Following resuscitated out-of-hospital cardiac arrest (OHCA), inflammatory markers are significantly elevated and associated with hemodynamic instability and organ dysfunction. Vasopressor support is recommended to maintain a mean arterial pressure (MAP) above 65 mmHg. Glucocorticoids have anti-inflammatory effects and may lower the need for vasopressors. This study aimed to assess the hemodynamic effects of prehospital high-dose glucocorticoid treatment in resuscitated comatose OHCA patients. METHODS The STEROHCA trial was a randomized, placebo-controlled, phase 2 trial comparing one prehospital injection of methylprednisolone 250 mg with placebo immediately after resuscitated OHCA. In this sub-study, we included patients who remained comatose at admission and survived until intensive care unit (ICU) admission. The primary outcome was cumulated norepinephrine use from ICU admission until 48 h reported as mcg/kg/min. Secondary outcomes included hemodynamic status characterized by MAP, heart rate, vasoactive-inotropic score (VIS), and the VIS/MAP-ratio as well as cardiac function assessed by pulmonary artery catheter measurements. Linear mixed-model analyses were performed to evaluate mean differences between treatment groups at all follow-up times. RESULTS A total of 114 comatose OHCA patients were included (glucocorticoid: n = 56, placebo: n = 58) in the sub-study. There were no differences in outcomes at ICU admission. From the time of ICU admission up to 48 h post-admission, patients in the glucocorticoid group cumulated a lower norepinephrine use (mean difference - 0.04 mcg/kg/min, 95% CI - 0.07 to - 0.01, p = 0.02). Moreover, after 12-24 h post-admission, the glucocorticoid group demonstrated a higher MAP with mean differences ranging from 6 to 7 mmHg (95% CIs from 1 to 12), a lower VIS (mean differences from - 4.2 to - 3.8, 95% CIs from - 8.1 to 0.3), and a lower VIS/MAP ratio (mean differences from - 0.10 to - 0.07, 95% CIs from - 0.16 to - 0.01), while there were no major differences in heart rate (mean differences from - 4 to - 3, 95% CIs from - 11 to 3). These treatment differences between groups were also present 30-48 h post-admission but to a smaller extent and with increased statistical uncertainty. No differences were found in pulmonary artery catheter measurements between groups. CONCLUSIONS Prehospital treatment with high-dose glucocorticoid was associated with reduced norepinephrine use in resuscitated OHCA patients. TRIAL REGISTRATION EudraCT number: 2020-000855-11; submitted March 30, 2020. URL: https://www. CLINICALTRIALS gov ; Unique Identifier: NCT04624776.
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Affiliation(s)
- Laust E R Obling
- Department of Cardiology, Rigshospitalet - Copenhagen University Hospital, Blegdamsvej 9, 2100, Copenhagen, OE, Denmark.
| | - Rasmus P Beske
- Department of Cardiology, Rigshospitalet - Copenhagen University Hospital, Blegdamsvej 9, 2100, Copenhagen, OE, Denmark
| | - Martin A S Meyer
- Department of Cardiology, Rigshospitalet - Copenhagen University Hospital, Blegdamsvej 9, 2100, Copenhagen, OE, Denmark
| | - Johannes Grand
- Department of Cardiology, Rigshospitalet - Copenhagen University Hospital, Blegdamsvej 9, 2100, Copenhagen, OE, Denmark
| | - Sebastian Wiberg
- Department of Cardiology, Rigshospitalet - Copenhagen University Hospital, Blegdamsvej 9, 2100, Copenhagen, OE, Denmark
- Department of Thoracic Anesthesiology, Rigshospitalet - Copenhagen University Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Thomas Mohr
- Department of Intensive Care, Herlev-Gentofte Hospital - Copenhagen University Hospital, Copenhagen, Denmark
| | - Anders Damm-Hejmdal
- Copenhagen Emergency Services, Capital Region of Denmark, Copenhagen, Denmark
| | - Julie L Forman
- Department of Public Health, Section of Biostatistics, University of Copenhagen, Copenhagen, Denmark
| | - Ruth Frikke-Schmidt
- Department of Clinical Biochemistry, Rigshospitalet - Copenhagen University Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Fredrik Folke
- Copenhagen Emergency Services, Capital Region of Denmark, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Cardiology, Herlev-Gentofte Hospital - Copenhagen University Hospital, Copenhagen, Denmark
| | - Jacob E Møller
- Department of Cardiology, Rigshospitalet - Copenhagen University Hospital, Blegdamsvej 9, 2100, Copenhagen, OE, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Jesper Kjaergaard
- Department of Cardiology, Rigshospitalet - Copenhagen University Hospital, Blegdamsvej 9, 2100, Copenhagen, OE, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Christian Hassager
- Department of Cardiology, Rigshospitalet - Copenhagen University Hospital, Blegdamsvej 9, 2100, Copenhagen, OE, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Smith D, Kenigsberg BB. Management of Patients After Cardiac Arrest. Crit Care Clin 2024; 40:57-72. [PMID: 37973357 DOI: 10.1016/j.ccc.2023.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
Cardiac arrest remains a significant cause of morbidity and mortality, although contemporary care now enables potential survival with good neurologic outcome. The core acute management goals for survivors of cardiac arrest are to provide organ support, sustain adequate hemodynamics, and evaluate the underlying cause of the cardiac arrest. In this article, the authors review the current state of knowledge and clinical intensive care unit practice recommendations for patients after cardiac arrest, particularly focusing on important areas of uncertainty, such as targeted temperature management, neuroprognostication, coronary evaluation, and hemodynamic targets.
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Affiliation(s)
- Damien Smith
- Department of Medicine, MedStar Washington Hospital Center, 110 Irving Street Northwest, Washington, DC 20010, USA
| | - Benjamin B Kenigsberg
- Department of Critical Care, MedStar Washington Hospital Center, 110 Irving Street Northwest, Washington, DC 20010, USA; Division of Cardiology, MedStar Washington Hospital Center, 110 Irving Street Northwest, Washington, DC 20010, USA.
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Poveda-Henao C, Valenzuela-Faccini N, Pérez-Garzón M, Mantilla-Viviescas K, Chavarro-Alfonso O, Robayo-Amortegui H. Neurological outcomes and quality of life in post-cardiac arrest patients with return of spontaneous circulation supported by ECMO: A retrospective case series. Medicine (Baltimore) 2023; 102:e35842. [PMID: 38115364 PMCID: PMC10727675 DOI: 10.1097/md.0000000000035842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 09/07/2023] [Accepted: 10/06/2023] [Indexed: 12/21/2023] Open
Abstract
Post-cardiac arrest brain injury constitutes a significant contributor to morbidity and mortality, leading to cognitive impairment and subsequent disability. Individuals within this patient cohort grapple with uncertainty regarding the potential advantages of extracorporeal life support (ECMO) cannulation. This study elucidates the neurological outcomes and quality of life of post-cardiac arrest patients who attained spontaneous circulation and underwent ECMO cannulation. This is a retrospective case study within a local context, the research involved 32 patients who received ECMO support following an intrahospital cardiac arrest with return of spontaneous circulation (ROSC). An additional 32 patients experienced cardiac arrest with ROSC before undergoing cannulation. The average age was 41 years, with the primary causes of cardiac arrest identified as acute coronary syndrome (46.8%), pulmonary thromboembolism (21.88%), and hypoxemia (18.7%). The most prevalent arrest rhythm was asystole (37.5%), followed by ventricular fibrillation (34.4%). The mean SOFA score was 7 points (IQR 6.5-9), APACHE II score was 12 (IQR 9-16), RESP score was -1 (IQR -1 to -4) in cases of respiratory ECMO, and SAVE score was -3 (IQR -5 to 2) in cases of cardiac ECMO. Overall survival was 71%, and at 6 months, the Barthel score was 75 points, modified Rankin score was 2, cerebral performance categories score was 1, and the SF-12 had an average score of 30. Notably, there were no significant associations between the time, cause, or rhythm of cardiac arrest and neurological outcomes. Importantly, cardiac arrest is not a contraindication for ECMO cannulation. A meticulous assessment of candidates who have achieved spontaneous circulation after cardiac arrest, considering the absence of early signs of poor neurological prognosis, is crucial in patient selection. Larger prospective studies are warranted to validate and extend these findings.
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Affiliation(s)
| | | | - Michel Pérez-Garzón
- Critical Medicine and Intensive Care, Fundación Clínica Shaio, Bogotá, Colombia
| | | | - Omar Chavarro-Alfonso
- Critical Medicine and Intensive Care resident, Universidad de La Sabana, Chía, Colombia
| | - Henry Robayo-Amortegui
- Critical Medicine and Intensive Care resident, Universidad de La Sabana, Chía, Colombia
- Grupo de Investigacion Clinica UPTC
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K SSNSP, Taksande A, Meshram RJ. Reviving Hope: A Comprehensive Review of Post-resuscitation Care in Pediatric ICUs After Cardiac Arrest. Cureus 2023; 15:e50565. [PMID: 38226102 PMCID: PMC10788704 DOI: 10.7759/cureus.50565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 12/15/2023] [Indexed: 01/17/2024] Open
Abstract
This comprehensive review thoroughly examines post-resuscitation care in pediatric ICUs (PICUs) following cardiac arrest. The analysis encompasses adherence to resuscitation guidelines, advances in therapeutic interventions, and the nuanced management of neurological, cardiovascular, and respiratory considerations during the immediate post-resuscitation phase. Delving into the complexities of long-term outcomes, cognitive and developmental considerations, and rehabilitation strategies, the review emphasizes the importance of family-centered care for pediatric survivors. A call to action is presented, urging continuous education, research initiatives, and quality improvement efforts alongside strengthened multidisciplinary collaboration and advocacy for public awareness. Through implementing these principles, healthcare providers and systems can collectively contribute to ongoing advancements in pediatric post-resuscitation care, ultimately improving outcomes and fostering a culture of excellence in pediatric critical care.
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Affiliation(s)
- Sri Sita Naga Sai Priya K
- Pediatrics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Amar Taksande
- Pediatrics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Revat J Meshram
- Pediatrics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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9
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Kjaergaard J, Møller JE. Haemodynamic, oxygenation, and ventilation targets after cardiac arrest: the current ABC of post-cardiac arrest intensive care. EUROPEAN HEART JOURNAL. ACUTE CARDIOVASCULAR CARE 2023; 12:513-517. [PMID: 37459572 DOI: 10.1093/ehjacc/zuad077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 07/06/2023] [Indexed: 08/26/2023]
Affiliation(s)
- Jesper Kjaergaard
- Department of Cardiology, The Heart Center, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, Copenhagen 2100, Denmark
- Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen, Denmark
| | - Jacob Eifer Møller
- Department of Cardiology, The Heart Center, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, Copenhagen 2100, Denmark
- Department of Cardiology, Odense University Hospital, JB Winsløvvej 4, Odense 5000, Denmark
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