Brain monitoring after cardiac arrest

Diagnostic value of combined detection of serum neuron-specific enolase and homocysteine in patients with coronary atherosclerosis

BACKGROUND

The aim of this paper was to investigate the diagnostic significance and severity assessment of serum neuron-specific enolase (NSE) combined with homocysteine (Hcy) for patients with coronary atherosclerosis (coronary artery disease, CAD).

METHODS

Two hundred sixty-three patients with coronary artery disease were selected as the research group, and 400 healthy individuals who underwent physical examination during the same period were taken as the control group. Electrochemiluminescence immunoassay and biochemical analyzer were employed to detect the serum NSE and Hcy levels of all subjects. The diagnostic value of combined and individual serum NSE and Hcy detection for the combined group was analyzed using the ROC curve.

RESULTS

The serum NSE (19.91±9.98 vs. 11.17±2.35) and Hcy levels (15.76±5.37 vs. 10.17±3.71) in the research group were significantly higher than those in the control group, with a statistically significant difference (P<0.05). The serum NSE (16.67±4.02 vs. 18.63±5.49 vs. 20.29±5.87) and Hcy levels (13.28±2.49 vs. 15.56±2.67 vs. 16.66±3.94) gradually increased across groups A, B, and C, and inter-group comparisons showed statistically significant differences (P<0.05). The AUC value of combined serum NSE and Hcy detection for CAD patients was higher (0.879 vs. 0.724 vs. 0.827) than individual NSE and Hcy testing. The specificity of Hcy for the diagnosis of CAD was the highest, reaching 90.3%. The sensitivity of combined NSE and Hcy (82.9%) was higher than the individual testing sensitivity of the two groups.

CONCLUSIONS

The combined detection of serum NSE and Hcy has high diagnostic efficacy for CAD and provides reference value in assessing the severity of the disease.

Assessment of frontal EEG measurement in out-of-hospital cardiac arrest: a prospective observational feasibility study - study protocol

INTRODUCTION

Nowadays, managing out-of-hospital cardiac arrest (OHCA) prioritises measures that achieve a good neurological outcome. Monitoring neurological function early is an essential step in identifying patients who could benefit from invasive techniques, such as extracorporeal membrane oxygenation, compared with patients suffering from irreversible hypoxic-ischaemic brain injury. Electroencephalography (EEG) has been used in the hospital; thus, its prehospital data are lacking. This study aimed to evaluate the feasibility of non-invasive EEG in the prehospital environment as a potential tool for neurological assessment.

METHODS AND ANALYSIS

This feasibility trial will recruit 45 OHCA patients aged 18 and over in the catchment area of the physician response unit at the University Hospital Graz, Austria. Two different measurement conditions will be assessed: (1) during the phase of cardiopulmonary resuscitation (CPR) and (2) after the return of spontaneous circulation for those who achieve this condition. EEG not only has the potential to provide an early neurological prognosis for immediate treatments or outcome-related decisions but can also aid in better managing CPR-induced consciousness.

ETHICS AND DISSEMINATION

The ethics committee of the Medical University of Graz (IRB00002556), decision number 35-352 ex 22/23, reviewed and approved this study protocol, registered at ClinicalTrials.gov (Identifier NCT06072092). The data generated from this research will be published openly alongside the study results.

TRIAL REGISTRATION NUMBER

NCT06072092.

Optimizing brain protection after cardiac arrest: advanced strategies and best practices

Cardiac arrest (CA) is associated with high incidence and mortality rates. Among patients who survive the acute phase, brain injury stands out as a primary cause of death or disability. Effective intensive care management, including targeted temperature management, seizure treatment and maintenance of normal physiological parameters, plays a crucial role in improving survival and neurological outcomes. Current guidelines advocate for neuroprotective strategies to mitigate secondary brain injury following CA, although certain treatments remain subjects of debate. Clinical examination and neuroimaging studies, both invasive and non-invasive neuromonitoring methods and serum biomarkers are valuable tools for predicting outcomes in comatose resuscitated patients. Neuromonitoring, in particular, provides vital insights for identifying complications, personalizing treatment approaches and forecasting prognosis in patients with brain injury post-CA. In this review, we offer an overview of advanced strategies and best practices aimed at optimizing brain protection after CA.

Hypoxic-ischemic brain injury in pig after cardiac arrest - A new histopathological scoring system for non-specialists

Introduction

After cardiac arrest and successful resuscitation patients often present with hypoxic-ischemic brain injury, which is a major cause of death due to poor neurological outcome. The development of a robust histopathological scoring system for the reliable and easy identification and quantification of hypoxic-ischemic brain injury could lead to a standardization in the evaluation of brain damage. We wanted to establish an easy-to-use neuropathological scoring system to identify and quantify hypoxic-ischemic brain injury.

Methods

The criteria for regular neurons, hypoxic-ischemic brain injury neurons and neurons with ischemic neuronal change (ischemic change neurons) were established in collaboration with specialized neuropathologists. Nine non-specialist examiners performed cell counting using the mentioned criteria in brain tissue samples from a porcine cardiac arrest model. The statistical analyses were performed using the interclass correlation coefficient for counting data and reliability testing.

Results

The inter-rater reliability for regular neurons (ICC 0.68 (0.42 - 0.84; p < 0.001) and hypoxic-ischemic brain injury neurons (ICC 0.87 (0.81 - 0.92; p < 0.001) showed moderate to excellent correlation while ischemic change neurons showed poor reliability. Excellent results were seen for intra-rater reliability for regular neurons (ICC 0.9 (0.68 - 0.97; p < 0.001) and hypoxic-ischemic brain injury neurons (ICC 0.99 (0.83 - 1; p < 0.001).

Conclusion

The scoring system provides a reliable method for the discrimination between regular neurons and neurons affected by hypoxic/ischemic injury. This scoring system allows an easy and reliable identification and quantification of hypoxic-ischemic brain injury for non-specialists and offers a standardization to evaluate hypoxic-ischemic brain injury after cardiac arrest.

Metabolically Glycoengineered Neural Stem Cells Boost Neural Repair After Cardiac Arrest

Cardiac arrest (CA)-induced cerebral ischemia remains challenging with high mortality and disability. Neural stem cell (NSC) engrafting is an emerging therapeutic strategy with considerable promise that, unfortunately, is severely compromised by limited cell functionality after in vivo transplantation. This groundbreaking report demonstrates that metabolic glycoengineering (MGE) using the "Ac5ManNTProp (TProp)" monosaccharide analog stimulates the Wnt/β-catenin pathway, improves cell adhesion, and enhances neuronal differentiation in human NSCs in vitro thereby substantially increasing the therapeutic potential of these cells. For the first time, MGE significantly enhances NSC efficacy for treating ischemic brain injury after asphyxia CA in rats. In particular, neurological deficit scores and neurobehavioral tests experience greater improvements when the therapeutic cells are pretreated with TProp than with "stand-alone" NSC therapy. Notably, the TProp-NSC group exhibits significantly stronger neuroprotective functions including enhanced differentiation, synaptic plasticity, and reduced microglia recruitment; furthermore, Wnt pathway agonists and inhibitors demonstrate a pivotal role for Wnt signaling in the process. These findings help establish MGE as a promising avenue for addressing current limitations associated with NSC transplantation via beneficially influencing neural regeneration and synaptic plasticity, thereby offering enhanced therapeutic options to boost brain recovery following global ischemia.

Innovative in vivo rat model for global cerebral hypoxia: a new approach to investigate therapeutic and preventive drugs

Introduction: Severe acute global cerebral hypoxia can lead to significant disability in humans. Although different animal models have been described to study hypoxia, there is no endogenous model that considers hypoxia and its effect on the brain as an independent factor. Thus, we developed a minimally invasive rat model, which is based on the non-depolarizing muscle blocking agent rocuronium in anesthetized animals. This drug causes respiratory insufficiency by paralysis of the striated muscles. Methods: In this study, 14 rats underwent 12 min of hypoxemia with an oxygen saturation of approximately 60% measured by pulse oximetry; thereafter, animals obtained sugammadex to antagonize rocuronium immediately. Results: Compared to controls (14 rats, anesthesia only), hypoxic animals demonstrated significant morphological alterations in the hippocampus (cell decrease in the CA 1 region) and the cerebellum (Purkinje cell decrease), as well as significant changes in hypoxia markers in blood (Hif2α, Il1β, Tgf1β, Tnfα, S100b, cspg2, neuron-specific enolase), hippocampus (Il1β, Tnfα, S100b, cspg2, NSE), and cerebellum (Hif1α, Tnfα, S100b, cspg2, NSE). Effects were more pronounced in females than in males. Discussion: Consequently, this model is suitable to induce hypoxemia with consecutive global cerebral hypoxia. As significant morphological and biochemical changes were proven, it can be used to investigate therapeutic and preventive drugs for global cerebral hypoxia.

The Changing Epidemiology of the Cardiac Intensive Care Unit

Coronary care units (CCUs) were originally designed to monitor and treat peri-infarction ventricular arrhythmias but have evolved into highly specialized cardiac intensive care units (CICUs) that provide care to a patient population that is increasingly heterogeneous and complex. Paralleling broader epidemiologic trends, patients admitted to contemporary CICUs are older and have a greater burden of cardiovascular and non-cardiovascular comorbidities. Moreover, contemporary CICU patients have high illness severity and often present with acute noncardiac organ dysfunction. In addition to these shifting demographic patterns, there have been important epidemiologic changes in CICU technologies, multidisciplinary systems of care, and physician staffing and training.