Hypothermia for Neuroprotection in Adults After Cardiac Arrest

Critical Care Nurse, Journal Year: 2023, Volume and Issue: 43(6), P. 77 - 79

Published: Dec. 1, 2023

What are the effects of therapeutic hypothermia after cardiac arrest on neurologic outcomes, survival, and adverse events?Cardiac refers to a sustained decrease in function heart without evidence circulation.1 Recent reports indicate that causes between 15% 20% deaths many countries.2 Those who survive have high risk harm due hypoxia resultant decreased quality life.3 Management strategies for include early cardiopulmonary resuscitation with defibrillation, circulatory support, temperature management.4 The use hypothermia, also referred as targeted management, may help protect against damage through several pathways, including slowing down inflammation process reducing cerebral metabolism edema.5 Although previous studies indicated induced was beneficial, some recent research has shown no benefit from this strategy potential harm.6 A retrospective analysis arrests US hospitals showed only 0.85% patients received management7; therefore, evaluation approach is warranted. Exploring recommendations systematic reviews, highest form evidence, can guide clinical decision-making.This review summary based an update previously published reviews topic conducted 2009, 2012, 2016.8 As new becomes available, updates necessary account results presents. This update, by Arrich et al8 2023, included 12 randomized controlled trials comprising 3956 adult participants.The team investigated outcomes main primary outcome, secondary pneumonia, hypokalemia, arrhythmia. These were assessed comparing practices (cooling 32–34 °C) standard management (>36 °C).Arrich independently bias each study, selection, performance, detection, attrition, reporting, publication biases (through visual inspection funnel plots). Any disagreements resolved reviewing data together discussing them. authors used ratios (RRs) 95% CIs measures treatment effect comparisons outcomes.8 They internationally approved GRADE (Grading Recommendations Assessment, Development Evaluation) determine certainty evidence—high, moderate, low, or very low—for outcome9: Low-certainty better group (RR, 1.41 [95% CI, 1.12-1.76]; 3914 participants).Low-certainty significant difference survival hospital discharge 2 groups 1.07 0.95-1.20]; 3871 pneumonia more frequent 1.09 1.00-1.18]; 3634 participants).Very-low-certainty hypokalemia 1.38 1.03-1.84]; 975 arrhythmias 1.40 1.19-1.64]; 2163 participants).This yielded low-certainty that, compared (temperature >36 °C), improve found terms survival. Given had increased frequency arrhythmias, appropriate plans be anticipated.Although findings aligned best current recommendations, ongoing warrants further investigation evaluation, potentially updated guidelines (eg, American Heart Association). Other did not outcomes.10,11 Some draw those conclusions graded low certainty, which suggests needed gain greater clarity. In contrast, different earlier year associated improved outcomes.12The varying these sources leave care teams unsure what their patients. Furthermore, even need critically appraised quality, inclusion exclusion parameters, relevance specific patient population before we consider basing practice changing practice. evaluating factor method cooling, specifically whether it intravascular cooling surface cooling. 1 option than cooling.12The other affect decisions development experienced arrest. An important part our role nurses caring ill advocating evidence-based treatment. We must always available understand feasibility, appropriateness, meaningfulness, effectiveness any intervention implement given situation.

Language: Английский

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Chinese clinical practice consensus for device-supported treatment in adults with post-cardiac arrest syndrome (2024 Edition)

World Journal of Emergency Medicine, Journal Year: 2025, Volume and Issue: 16(1), P. 3 - 3

Published: Jan. 1, 2025

Language: Английский

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Endogenous recovery of hippocampal function following global cerebral ischemia in juvenile female mice is influenced by neuroinflammation and circulating sex hormones.

bioRxiv (Cold Spring Harbor Laboratory), Journal Year: 2025, Volume and Issue: unknown

Published: Jan. 31, 2025

Abstract Cardiac arrest-induced global cerebral ischemia (GCI) in childhood often results learning and memory deficits. We previously demonstrated a murine cardiac arrest cardiopulmonary resuscitation (CA/CPR) mouse model that cellular mechanism of memory, long-term potentiation (LTP), is acutely impaired the hippocampus juvenile males, correlating with deficits tasks. However, little known regarding plasticity impairments females. performed CA/CPR (P21-25) female mice used slice electrophysiology hippocampal dependent behavior to assess function. LTP was contextual fear were 7-days after GCI endogenously recovered by 30-days. remained at 30 days ovariectomized females, suggesting surge gonadal sex hormones during puberty mediates endogenous recovery. Unlike recovery females not associated BDNF expression. NanoString transcriptional analysis revealed potential role neuroinflammatory processes, specifically Cd68 pathways, impairment hormone-dependent able restore chronic acute PPT administration, implicating estrogen receptor alpha mechanisms. This study supports which differs mechanistically from males does occur adults either sex.

Language: Английский

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Design of the OverCool Study: lung-cOnservative liquid VEntilation for the induction of ultra-Rapid COOLing after cardiac arrest (OverCool)

Resuscitation Plus, Journal Year: 2025, Volume and Issue: 23, P. 100926 - 100926

Published: March 11, 2025

The therapeutic window within which induced hypothermia might be effective after cardiac arrest is still unknown. In animal models, early induction and faster cooling are independently associated favorable outcome. However, of Ultra-Rapid Therapeutic Hypothermia (achieving core body temperature 33.0 ± 0.5 °C 60 min the start procedure) need to evaluated in human setting. Total liquid ventilation with temperature-controlled breathable liquids provided such rapid (i.e. >15 °C/h rate) both small large animals. This method was shown improve neurological outcome A new medical device system, Vent2Cool, developed for clinical use Intensive Care Unit achieve ultra-rapid by total patients. non-blinded single-arm OverCool pilot trial will evaluate feasibility, performance safety 24 patients resuscitated in- or out-of-hospital arrest. Inclusion criteria include presumption procedure less than 120 resuscitation. primary achievement a °C, as well successful return conventional gas <60 initiation. Secondary outcomes time reach target temperature, vital status, systemic pulmonary parameters modified-Rankin Score at 28 days post- study validate using NCT06798818. Authorized French "Agence nationale de sécurité du médicament et des produits santé" "Comité Protection Personnes" (Ethics Committee).

Language: Английский

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Visual coronary artery calcification score to predict significant coronary artery stenosis in patients presenting with cardiac arrest without ST-segment elevation myocardial infarction

Annals of Intensive Care, Journal Year: 2025, Volume and Issue: 15(1)

Published: April 7, 2025

Language: Английский

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Single cell RNA sequencing after moderate traumatic brain injury: effects of therapeutic hypothermia

Journal of Neuroinflammation, Journal Year: 2025, Volume and Issue: 22(1)

Published: April 18, 2025

Traumatic brain injury (TBI) initiates a cascade of cellular and molecular events that promote acute long-term patterns neuronal, glial, vascular, synaptic vulnerability leading to lasting neurological deficits. These complex responses lead programmed cell death, diffuse axonal injury, increased blood-brain barrier disruption, neuroinflammation, reactive gliosis, each potential target for therapeutic interventions. Posttraumatic hypothermia (TH) has been reported be highly protective after spinal cord studies have investigated mechanisms underlying mild hypothermic protection while commonly assessing heterogenous populations. In this study we conducted single-cell RNA sequencing (scRNA-seq) on cerebral cortical tissues experimental TBI followed by period normothermia or comprehensively assess multiple type-specific transcriptional responses. C57BL/6 mice underwent moderate controlled impact (CCI) sham surgery then placed under sustained (37⁰C) (33⁰C) 2 h. After 24 h, including peri-contused regions were processed scRNA-seq. Unbiased clustering revealed heterogeneity among glial immune cells at subacute posttraumatic time point. The analysis also vascular subtypes associated with neovascularization debris clearance, respectively. Compared normothermic conditions, TH treatment altered the abundance specific induced astrocyte-specific modulation neurotropic factor gene expression. addition, an increase in proportion endothelial tip group was documented compared normothermia. data emphasize importance early temperature-sensitive processes producing potentially neuroprotective downstream signaling cascades cell-type-dependent manner. use scRNA-seq address treatments provides valuable resource identifying targetable biological pathways development reparative

Language: Английский

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Treatment of Refractory Cardiac Arrest by Controlled Reperfusion of the Whole Body: A Multicenter, Prospective Observational Study

Journal of Clinical Medicine, Journal Year: 2023, Volume and Issue: 13(1), P. 56 - 56

Published: Dec. 21, 2023

Background: Survival following cardiac arrest (CA) remains poor after conventional cardiopulmonary resuscitation (CCPR) (6–26%), and the outcomes extracorporeal (ECPR) are often inconsistent. Poor survival is a consequence of CA, low-flow states during CCPR, multi-organ injury, insufficient monitoring, delayed treatment causative condition. We developed new strategy to address these issues. Methods: This all-comers, multicenter, prospective observational study (69 patients with in- out-of-hospital CA (IHCA OHCA) prolonged refractory CCPR) focused on support, comprehensive repair, potential for cannulation treatment. Result: The overall rate at hospital discharge was 42.0%, favorable neurological outcome (CPC 1+2) 90 days achieved 79.3% survivors 1+2 33%). IHCA very (51.7%), as CPC (41%). OHCA 35% 28%. subgroup pre-hospital showed superior 57.1%. Conclusions: focusing repairing damage multiple organs appears improve findings should provide sound basis further research in this area.

Language: Английский

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Mild therapeutic hypothermia after cardiac arrest – effect on survival with good neurological outcome outside of randomised controlled trials

European Journal of Anaesthesiology, Journal Year: 2024, Volume and Issue: 41(10), P. 779 - 786

Published: May 27, 2024

BACKGROUND For nearly 20 years, in international guidelines, mild therapeutic hypothermia (MTH) was an important component of postresuscitation care. However, recent randomised controlled trials have questioned its benefits. At present, guidelines only recommend actively preventing fever, but there are ongoing discussions about whether the majority cardiac arrest patients could benefit from MTH treatment. OBJECTIVE The aim this study to compare outcome adult treated with and without after arrest. DESIGN Observational cohort study. SETTING German Resuscitation Registry covering more than 31 million inhabitants Germany Austria. PATIENTS All between 2006 2022 out-of-hospital or in-hospital comatose on admission. MAIN OUTCOME MEASURES Primary endpoint: hospital discharge good neurological [cerebral performance categories (CPC) 1 2]. Secondary discharge. We used a multivariate binary logistic regression analysis identify effects all known influencing variables. RESULTS analysed 33 933 (10 034 MTH, 23 899 MTH). model revealed that independent predictor CPC 1/2 survival odds ratio (95% confidence intervals) 1.60 (1.49 1.72), P < 0.001 1.89 (1.76 2.02), 0.001, respectively. CONCLUSION Our data indicate existence positive association favourable It therefore seems premature refrain giving treatment for entire spectrum Further prospective studies needed.

Language: Английский

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Temperature Control in Acute Brain Injury: An Update

Seminars in Neurology, Journal Year: 2024, Volume and Issue: 44(03), P. 308 - 323

Published: April 9, 2024

Abstract Temperature control in severe acute brain injury (SABI) is a key component of management. This manuscript delves into the complex role temperature management SABI, encompassing conditions like traumatic (TBI), ischemic stroke (AIS), intracerebral hemorrhage (ICH), aneurysmal subarachnoid (aSAH), and hypoxemic/ischemic following cardiac arrest. Fever common complication SABI linked to worse neurological outcomes due increased inflammatory responses intracranial pressure (ICP). management, particularly hypothermic (HTC), appears mitigate these adverse effects primarily by reducing cerebral metabolic demand dampening pathways. However, effectiveness HTC varies across different conditions. In context post-cardiac arrest, impact on has shown inconsistent results. cases TBI, seems promising for ICP, but its influence long-term remains uncertain. For AIS, clinical trials have yet conclusively demonstrate benefits HTC, despite encouraging preclinical evidence. variability efficacy also observed ICH, aSAH, bacterial meningitis, status epilepticus. pediatric neonatal populations, while shows significant hypoxic-ischemic encephalopathy, other injuries mixed. Although theoretical basis employing control, especially strong, differ among various subtypes. The current consensus indicates that fever prevention beneficial board, application are more nuanced, underscoring need further research establish optimal strategies. Here we provide an overview evidence surrounding use types SABI.

Language: Английский

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Ketone Bodies after Cardiac Arrest: A Narrative Review and the Rationale for Use

Cells, Journal Year: 2024, Volume and Issue: 13(9), P. 784 - 784

Published: May 4, 2024

Cardiac arrest survivors suffer the repercussions of anoxic brain injury, a critical factor influencing long-term prognosis. This injury is characterised by profound and enduring metabolic impairment. Ketone bodies, an alternative energetic resource in physiological states such as exercise, fasting, extended starvation, are avidly taken up used brain. Both ketogenic diet exogenous ketone supplementation have been associated with neuroprotective effects across spectrum conditions. These include refractory epilepsy, neurodegenerative disorders, cognitive impairment, focal cerebral ischemia, traumatic injuries. Beyond this, bodies possess plethora attributes that appear to be particularly favourable after cardiac arrest. encompass anti-inflammatory effects, attenuation oxidative stress, improvement mitochondrial function, glucose-sparing effect, enhancement function. The aim this manuscript appraise pertinent scientific literature on topic through narrative review. We encapsulate existing evidence underscore potential therapeutic value context provide rationale for their use forthcoming translational research efforts.

Language: Английский

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