The dynamic pathophysiology of post cardiac arrest brain injury: “time is brain” DOI

C. Allen,

Jordan Bird, Mypinder S. Sekhon

et al.

Current Opinion in Critical Care, Journal Year: 2025, Volume and Issue: unknown

Published: Feb. 28, 2025

To review the time dependent nature of postcardiac arrest brain injury (PCABI) while contextualizing clinical trial evidence. PCABI represents a dynamic entity with respect to its pathophysiology. Intuitively, pathophysiology has been characterized focusing on mechanisms associated cerebral ischemia. Interventions that augment oxygen delivery, such as increasing mean arterial pressure, have garnered interest. Regrettably, these trials not demonstrated improved outcomes. At core this conundrum is employing interventions approximately 4-6 h after return spontaneous circulation (ROSC). This therapeutic window likely far past efficacy period resumption delivery ischemic brain. Thus, we suggest compartmentalizing into four phases: circulatory arrest; intra-arrest physiology; immediate reperfusion; and delayed reperfusion. Culprit are discussed for each phase contextualization recent results. restoration in manner from ROSC diminished efficacy. must be viewed aimed at restoring only efficacious if applied immediately ROSC.

Language: Английский

The Lancet Commission to reduce the global burden of sudden cardiac death: a call for multidisciplinary action DOI
Éloi Marijon, Kumar Narayanan, Karen Smith

et al.

The Lancet, Journal Year: 2023, Volume and Issue: 402(10405), P. 883 - 936

Published: Aug. 27, 2023

Language: Английский

Citations

96
2023 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations: Summary From the Basic Life Support; Advanced Life Support; Pediatric Life Support; Neonatal Life Support; Education, Implementation, and Teams; and First Aid Task Forces DOI Creative Commons
Katherine M. Berg, Janet Bray, Tzong-Luen Wang

et al.

Circulation, Journal Year: 2023, Volume and Issue: 148(24)

Published: Nov. 9, 2023

The International Liaison Committee on Resuscitation engages in a continuous review of new, peer-reviewed, published cardiopulmonary resuscitation and first aid science. Draft Consensus Science With Treatment Recommendations are posted online throughout the year, this annual summary provides more concise versions final from all task forces for year. Topics addressed by systematic reviews year include cardiac arrest drowning, extracorporeal adults children, calcium during arrest, double sequential defibrillation, neuroprognostication after maintaining normal temperature preterm birth, heart rate monitoring methods diagnostics neonates, detection exhaled carbon dioxide family presence adults, stepwise approach to skills training. Members 6 have assessed, discussed, debated quality evidence, using Grading Assessment, Development, Evaluation criteria, their statements consensus treatment recommendations. Insights into deliberations provided Justification Evidence-to-Decision Framework Highlights sections. In addition, list priority knowledge gaps further research. Additional topics with scoping evidence updates.

Language: Английский

Citations

61
2023 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations: Summary From the Basic Life Support; Advanced Life Support; Pediatric Life Support; Neonatal Life Support; Education, Implementation, and Teams; and First Aid Task Forces DOI Creative Commons
Katherine M. Berg, Janet Bray, Tzong-Luen Wang

et al.

Resuscitation, Journal Year: 2023, Volume and Issue: 195, P. 109992 - 109992

Published: Nov. 9, 2023

The International Liaison Committee on Resuscitation engages in a continuous review of new, peer-reviewed, published cardiopulmonary resuscitation and first aid science. Draft Consensus Science With Treatment Recommendations are posted online throughout the year, this annual summary provides more concise versions final from all task forces for year. Topics addressed by systematic reviews year include cardiac arrest drowning, extracorporeal adults children, calcium during arrest, double sequential defibrillation, neuroprognostication after maintaining normal temperature preterm birth, heart rate monitoring methods diagnostics neonates, detection exhaled carbon dioxide family presence adults, stepwise approach to skills training. Members 6 have assessed, discussed, debated quality evidence, using Grading Assessment, Development, Evaluation criteria, their statements consensus treatment recommendations. Insights into deliberations provided Justification Evidence-to-Decision Framework Highlights sections. In addition, list priority knowledge gaps further research. Additional topics with scoping evidence updates.

Language: Английский

Citations

50
Conservative versus Liberal Oxygenation Targets in Intensive Care Unit Patients (ICONIC): A Randomized Clinical Trial DOI Creative Commons
Lea Imeen van der Wal, Chloe C.A. Grim,

Michael R. del Prado

et al.

American Journal of Respiratory and Critical Care Medicine, Journal Year: 2023, Volume and Issue: 208(7), P. 770 - 779

Published: Aug. 8, 2023

Supplemental oxygen is widely administered to ICU patients, but appropriate oxygenation targets remain unclear.

Language: Английский

Citations

39
Interplay of hypoxia-inducible factors and oxygen therapy in cardiovascular medicine DOI
Yafen Liang, Wei Ruan, Yandong Jiang

et al.

Nature Reviews Cardiology, Journal Year: 2023, Volume and Issue: 20(11), P. 723 - 737

Published: June 12, 2023

Language: Английский

Citations

29
Clinical targeting of the cerebral oxygen cascade to improve brain oxygenation in patients with hypoxic–ischaemic brain injury after cardiac arrest DOI Creative Commons
Ryan L. Hoiland, Chiara Robba,

David K. Menon

et al.

Intensive Care Medicine, Journal Year: 2023, Volume and Issue: 49(9), P. 1062 - 1078

Published: July 28, 2023

The cerebral oxygen cascade includes three key stages: (a) convective delivery representing the bulk flow of to vascular bed; (b) diffusion from blood into brain tissue; and (c) cellular utilisation for aerobic metabolism. All stages may become dysfunctional after resuscitation cardiac arrest contribute hypoxic–ischaemic injury (HIBI). Improving by optimising has been widely investigated as a strategy mitigate HIBI. However, clinical trials aimed at have yielded neutral results. Advances in understanding HIBI pathophysiology suggest that impairments pertaining should also be considered identifying therapeutic strategies management patients. Culprit mechanisms these include widening barrier due peri-vascular oedema mitochondrial dysfunction. An integrated approach encompassing both intra-parenchymal non-invasive neuromonitoring techniques aid detecting pathophysiologic changes enable patient-specific reducing severity

Language: Английский

Citations

23
Canadian Cardiovascular Society/Canadian Cardiovascular Critical Care Society/Canadian Association of Interventional Cardiology Clinical Practice Update on Optimal Post Cardiac Arrest and Refractory Cardiac Arrest Patient Care DOI Open Access
Sean van Diepen,

Michel R. Le May,

Patricia Alfaro

et al.

Canadian Journal of Cardiology, Journal Year: 2024, Volume and Issue: 40(4), P. 524 - 539

Published: April 1, 2024

Language: Английский

Citations

10
Improving Outcomes After Post–Cardiac Arrest Brain Injury: A Scientific Statement From the International Liaison Committee on Resuscitation DOI
Gavin D. Perkins, Robert W. Neumar, Cindy H. Hsu

et al.

Circulation, Journal Year: 2024, Volume and Issue: 150(7)

Published: June 27, 2024

This scientific statement presents a conceptual framework for the pathophysiology of post–cardiac arrest brain injury, explores reasons previous failure to translate preclinical data clinical practice, and outlines potential paths forward. Post–cardiac injury is characterized by 4 distinct but overlapping phases: ischemic depolarization, reperfusion repolarization, dysregulation, recovery repair. Previous research has been challenging because limitations laboratory models; heterogeneity in patient populations enrolled; overoptimistic estimation treatment effects leading suboptimal sample sizes; timing route intervention delivery; limited or absent evidence that engaged mechanistic target; postresuscitation care, prognostication, withdrawal life-sustaining treatments. Future trials must tailor their interventions subset patients most likely benefit deliver this at appropriate time, through route, dose. The complexity suggests monotherapies are unlikely be as successful multimodal neuroprotective therapies. Biomarkers should developed identify with targeted mechanism quantify its severity, measure response therapy. Studies need adequately powered detect effect sizes realistic meaningful patients, families, clinicians. Study designs optimized accelerate evaluation promising interventions. Multidisciplinary international collaboration will essential realize goal developing effective therapies injury.

Language: Английский

Citations

9
Pre‐hospital freeze‐dried plasma for critical bleeding after trauma: A pilot randomized controlled trial DOI Creative Commons
Biswadev Mitra, Ben Meadley, Stephen Bernard

et al.

Academic Emergency Medicine, Journal Year: 2023, Volume and Issue: 30(10), P. 1013 - 1019

Published: April 27, 2023

Abstract Objectives Transfusion of a high ratio plasma to packed red blood cells (PRBCs), treat or prevent acute traumatic coagulopathy, has been associated with survival after major trauma. However, the effect prehospital on patient outcomes inconsistent. The aim this pilot trial was assess feasibility transfusing freeze‐dried (RBCs) using randomized controlled design in an Australian aeromedical setting. Methods Patients attended by helicopter emergency medical service (HEMS) paramedics suspected critical bleeding trauma managed RBCs were receive 2 units (Lyoplas N‐w) standard care (no plasma). primary outcome proportion eligible patients enrolled and provided intervention. Secondary included preliminary data effectiveness, including mortality censored at 24 h hospital discharge, adverse events. Results During study period June 1 October 31, 2022, there 25 patients, whom 20 (80%) 19 (76%) received allocated Median time from randomization arrival 92.5 min (IQR 68–101.5 min). Mortality may have lower group (RR 0.24, 95% CI 0.03–1.73) discharge 0.73, 0.24–2.27). No serious events related interventions reported. Conclusions This first reported experience use Australia suggests administration is feasible. Given longer times typically HEMS attendance, potential clinical benefit intervention rationale for definitive trial.

Language: Английский

Citations

22
Targeted temperature management with hypothermia for comatose patients after cardiac arrest DOI Creative Commons
Clifton W. Callaway

Clinical and Experimental Emergency Medicine, Journal Year: 2023, Volume and Issue: 10(1), P. 5 - 17

Published: Feb. 16, 2023

Targeted temperature management with mild hypothermia (TTM-hypothermia; 32-34 °C) is a treatment strategy for adult patients who are comatose after cardiac arrest. Robust preclinical data support the beneficial effects of beginning within 4 hours reperfusion and maintained during several days postreperfusion brain dysregulation. TTM-hypothermia increased survival functional recovery arrest in trials realworld implementation studies. also benefits neonates hypoxic-ischemic injury. However, larger methodologically more rigorous do not detect benefit. Reasons inconsistency include difficulty delivering differential between randomized groups use shorter durations treatment. Furthermore, enrolled populations that vary illness severity injury, individual enriched higher or lower severity. There interactions effect. Current indicate implemented quickly arrest, may benefit select at risk severe injury but other patients. More needed on how to identify treatment-responsive titrate timing duration TTM-hypothermia.

Language: Английский

Citations

18