Neuromonitoring in Critically Ill Patients DOI Open Access
Swarna Rajagopalan, Aarti Sarwal

Critical Care Medicine, Journal Year: 2023, Volume and Issue: 51(4), P. 525 - 542

Published: Feb. 16, 2023

OBJECTIVES: Critically ill patients are at high risk of acute brain injury. Bedside multimodality neuromonitoring techniques can provide a direct assessment physiologic interactions between systemic derangements and intracranial processes offer the potential for early detection neurologic deterioration before clinically manifest signs occur. Neuromonitoring provides measurable parameters new or evolving injury that be used as target investigating various therapeutic interventions, monitoring treatment responses, testing clinical paradigms could reduce secondary improve outcomes. Further investigations may also reveal markers assist in neuroprognostication. We an up-to-date summary applications, risks, benefits, challenges invasive noninvasive modalities. DATA SOURCES: English articles were retrieved using pertinent search terms related to PubMed CINAHL. STUDY SELECTION: Original research, review articles, commentaries, guidelines. EXTRACTION: Syntheses data from relevant publications summarized into narrative review. SYNTHESIS: A cascade cerebral pathophysiological compound neuronal damage critically patients. Numerous modalities their applications have been investigated monitor range processes, including assessments, electrophysiology tests, blood flow, substrate delivery, utilization, cellular metabolism. Most studies focused on traumatic injury, with paucity other types concise most commonly techniques, associated bedside application, implications common findings guide evaluation management CONCLUSIONS: essential tool facilitate critical care. Awareness nuances use empower intensive care team tools potentially burden morbidity

Language: Английский

A Randomized Trial of Drug Route in Out-of-Hospital Cardiac Arrest DOI
Keith Couper, Chen Ji,

Charles D. Deakin

et al.

New England Journal of Medicine, Journal Year: 2024, Volume and Issue: unknown

Published: Oct. 31, 2024

In patients with out-of-hospital cardiac arrest, the effectiveness of drugs such as epinephrine is highly time-dependent. An intraosseous route drug administration may enable more rapid than an intravenous route; however, its effect on clinical outcomes uncertain.

Language: Английский

Citations

16
Personalized neuron-specific enolase level based on EEG pattern for prediction of poor outcome after cardiac arrest DOI Creative Commons

Juliette Pelle,

Estelle Pruvost‐Robieux, Florence Dumas

et al.

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

Published: Jan. 17, 2025

After cardiac arrest (CA), the European recommendations suggest to use a neuron-specific enolase (NSE) level > 60 µg/L at 48-72 h predict poor outcome. However, prognostic performance of NSE can vary depending on electroencephalogram (EEG). The objective was determine whether threshold which predicts outcome varies according EEG patterns and effect electrographic seizures level. A retrospective study conducted in tertiary CA center, using prospective registry 155 adult patients comatose 72 after CA. were classified Westhall classification (benign, malignant or highly malignant). Neurological evaluated CPC scale 3 months (CPC 3-5 defining outcome). Participants 64 years old (IQR [53; 72,5]), 74% male. 83% out-of-hospital 48% initial shockable rhythm. Electrographic observed 5% 8% good patients, respectively (p = 0.50). blood levels significantly lower (median 20 IQR [15; 30]) compared group 110 µg/l [49;308], p < 0,001). Benign associated with 0.001). not increased as 0.15). In EEG, 45.2 predictive unfavorable 100% specificity higher sensitivity (70.8%) recommended cut-off (Se 66%). Combined seizures, 53.5 (77.7%) 66.6%). benign 78.2 (Sp 100%) 94%). AC, personalized approach pattern could improve this biomarker for prediction. Compared others no significant difference case seizures.

Language: Английский

Citations

2
Continuous deep sedation versus minimal sedation after cardiac arrest and resuscitation (SED‐CARE): A protocol for a randomized clinical trial DOI Creative Commons
Ameldina Ceric, Josef Dankiewicz, Johanna Hästbacka

et al.

Acta Anaesthesiologica Scandinavica, Journal Year: 2025, Volume and Issue: 69(5)

Published: April 3, 2025

Abstract Background Sedation is often provided to resuscitated out‐of‐hospital cardiac arrest (OHCA) patients tolerate post‐cardiac care, including temperature management. However, the evidence of benefit or harm from routinely administered deep sedation after limited. The aim this trial investigate effects continuous compared minimal on patient‐important outcomes in OHCA a large clinical trial. Methods SED‐CARE part 2 × factorial Sedation, Temperature and Pressure Cardiac Arrest Resuscitation (STEPCARE) trial, randomized international, multicentre, parallel‐group, investigator‐initiated, superiority with three simultaneous intervention arms. In adults sustained return spontaneous circulation (ROSC) who are comatose following resuscitation will be within 4 hours (Richmond agitation scale (RASS) −4/−5) ( ) (RASS 0 −2) comparator ), for 36 h ROSC. primary outcome all‐cause mortality at 6 months randomization. two other components STEPCARE evaluate control strategies. Apart interventions, all aspects general intensive care according local practices participating site. Neurological prognostication performed European Council Society Intensive Care Medicine guidelines by physician blinded allocation group. To detect an absolute risk reduction 5.6% alpha 0.05, 90% power, 3500 participants enrolled. secondary proportion poor functional randomization, serious adverse events unit, patient‐reported overall health status Conclusion if confers arrest.

Language: Английский

Citations

2
Targeted temperature management following out-of-hospital cardiac arrest: a systematic review and network meta-analysis of temperature targets DOI
Shannon M. Fernando, Pietro Di Santo, Behnam Sadeghirad

et al.

Intensive Care Medicine, Journal Year: 2021, Volume and Issue: 47(10), P. 1078 - 1088

Published: Aug. 13, 2021

Language: Английский

Citations

86
Serum markers of brain injury can predict good neurological outcome after out-of-hospital cardiac arrest DOI Creative Commons
Marion Moseby-Knappe, Niklas Mattsson, Pascal Stammet

et al.

Intensive Care Medicine, Journal Year: 2021, Volume and Issue: 47(9), P. 984 - 994

Published: Aug. 21, 2021

The majority of unconscious patients after cardiac arrest (CA) do not fulfill guideline criteria for a likely poor outcome, their prognosis is considered "indeterminate". We compared brain injury markers in blood prediction good outcome and identifying false positive predictions as recommended by guidelines.

Language: Английский

Citations

80
Electroencephalogram in the intensive care unit: a focused look at acute brain injury DOI
Ayham Alkhachroum, Brian Appavu,

Satoshi Egawa

et al.

Intensive Care Medicine, Journal Year: 2022, Volume and Issue: 48(10), P. 1443 - 1462

Published: Aug. 23, 2022

Language: Английский

Citations

59
Effect of Moderate vs Mild Therapeutic Hypothermia on Mortality and Neurologic Outcomes in Comatose Survivors of Out-of-Hospital Cardiac Arrest DOI Open Access

Michel Le May,

Christina Osborne, Juan Russo

et al.

JAMA, Journal Year: 2021, Volume and Issue: 326(15), P. 1494 - 1494

Published: Oct. 19, 2021

Importance

Comatose survivors of out-of-hospital cardiac arrest experience high rates death and severe neurologic injury. Current guidelines recommend targeted temperature management at 32 °C to 36 for 24 hours. However, small studies suggest a potential benefit targeting lower body temperatures.

Objective

To determine whether moderate hypothermia (31 °C), compared with mild (34 improves clinical outcomes in comatose arrest.

Design, Setting, Participants

Single-center, double-blind, randomized, superiority trial carried out tertiary care center eastern Ontario, Canada. A total 389 patients were enrolled between August 4, 2013, March 20, 2020, final follow-up on October 15, 2020.

Interventions

Patients randomly assigned target 31 (n = 193) or 34 196) period

Main Outcomes Measures

The primary outcome was all-cause mortality poor 180 days. Neurologic assessed using the Disability Rating Scale, defined as score greater than 5 (range, 0-29, 29 being worst [vegetative state]). There 19 secondary outcomes, including days length stay intensive unit.

Results

Among 367 included analysis (mean age, 61 years; 69 women [19%]), 366 (99.7%) completed trial. occurred 89 184 (48.4%) group 83 183 (45.4%) (risk difference, 3.0% [95% CI, 7.2%-13.2%]; relative risk, 1.07 0.86-1.33];P .56). Of 18 not statistically significant. Mortality 43.5% 41.0% treated °C, respectively (P .63). median unit longer (10 vs 7 days;P .004). adverse events group, deep vein thrombosis 11.4% 10.9% thrombus inferior vena cava 3.8% 7.7%, respectively.

Conclusions Relevance

In arrest, did significantly reduce rate °C. study may have been underpowered detect clinically important difference.

Trial Registration

ClinicalTrials.gov Identifier:NCT02011568

Language: Английский

Citations

58
ERC-ESICM guidelines on temperature control after cardiac arrest in adults DOI Creative Commons
Jerry P. Nolan, Claudio Sandroni, Lars W. Andersen

et al.

Resuscitation, Journal Year: 2022, Volume and Issue: 172, P. 229 - 236

Published: Feb. 4, 2022

The aim of these guidelines is to provide evidence‑based guidance for temperature control in adults who are comatose after resuscitation from either in-hospital or out-of-hospital cardiac arrest, regardless the underlying rhythm. These replace recommendations on management arrest included 2021 post-resuscitation care co-issued by European Resuscitation Council (ERC) and Society Intensive Care Medicine (ESICM).The guideline panel thirteen international clinical experts authored ERC-ESICM two methodologists participated evidence review completed behalf International Liaison Committee (ILCOR) whom ERC a member society. We followed Grading Recommendations Assessment, Development, Evaluation (GRADE) approach assess certainty grade recommendations. provided suggestions implementation identified priorities future research.The ranged moderate low. In patients remain we recommend continuous monitoring core actively preventing fever (defined as > 37.7 °C) at least 72 hours. There was insufficient against 32–36 °C early cooling arrest. not rewarming with mild hypothermia return spontaneous circulation (ROSC) achieve normothermia. using prehospital rapid infusion large volumes cold intravenous fluids immediately ROSC.

Language: Английский

Citations

54
Oxygen targets and 6-month outcome after out of hospital cardiac arrest: a pre-planned sub-analysis of the targeted hypothermia versus targeted normothermia after Out-of-Hospital Cardiac Arrest (TTM2) trial DOI Creative Commons
Chiara Robba, Rafael Badenes, Denise Battaglini

et al.

Critical Care, Journal Year: 2022, Volume and Issue: 26(1)

Published: Oct. 21, 2022

Abstract Background Optimal oxygen targets in patients resuscitated after cardiac arrest are uncertain. The primary aim of this study was to describe the values partial pressure (PaO 2 ) and episodes hypoxemia hyperoxemia occurring within first 72 h mechanical ventilation out hospital (OHCA) patients. secondary evaluate association PaO with patients’ outcome. Methods Preplanned analysis targeted hypothermia versus normothermia OHCA (TTM2) trial. Arterial blood gases were collected from randomization every 4 for 32 h, then, 8 until day 3. Hypoxemia defined as < 60 mmHg severe > 300 mmHg. Mortality poor neurological outcome (defined according modified Rankin scale) at 6 months. Results 1418 included analysis. mean age 64 ± 14 years, 292 (20.6%) female. 24.9% had least one episode hypoxemia, 7.6% hyperoxemia. Both independently associated 6-month mortality, but not best cutoff point mortality 69 (Risk Ratio, RR = 1.009, 95% CI 0.93–1.09), 195 (RR 1.006, 0.95–1.06). time exposure, i.e., area under curve -AUC), significantly ( p 0.003). Conclusions In patients, both 6-months an effect mediated by timing exposure high oxygen. Precise titration levels should be considered group Trial registration : clinicaltrials.gov NCT02908308 , Registered September 20, 2016.

Language: Английский

Citations

48
In-hospital versus out-of-hospital cardiac arrest: Characteristics and outcomes in patients admitted to intensive care after return of spontaneous circulation DOI Creative Commons
Axel Andersson, Isabelle Arctaedius, Tobias Cronberg

et al.

Resuscitation, Journal Year: 2022, Volume and Issue: 176, P. 1 - 8

Published: April 28, 2022

IntroductionCardiac arrest is characterized depending on location as in-hospital cardiac (IHCA) or out-of-hospital (OHCA). Strategies for Post Cardiac Arrest Care were developed based evidence from OHCA. The aim of this study was to compare characteristics and outcomes in patients admitted intensive care after IHCA OHCA.MethodsA retrospective multicenter observational adult survivors southern Sweden between 2014–2018. Data collected registries medical notes. primary outcome neurological according the Cerebral Performance Category (CPC) scale at 2–6 months.Results799 included, 245 554 older, less frequently male without comorbidity. In first recorded rhythm more often non-shockable, all delay-times (ROSC, no-flow, low-flow, time advanced life support) shorter a cause common. Good long-term common than multivariable analysis, witnessed arrest, age, duration (no-flow low-flow times), low lactate, shockable rhythm, independent predictors good whereas (IHCA vs OHCA) not.ConclusionIn who suffered OHCA differed demographics, co-morbidities, outcomes. analyses, outcome, not.

Language: Английский

Citations

47