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

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

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Continuous deep sedation versus minimal sedation after cardiac arrest and resuscitation (SED‐CARE): A protocol for a randomized clinical trial

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

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Temperature Control After In-Hospital Cardiac Arrest: A Randomized Clinical Trial

Circulation, Journal Year: 2022, Volume and Issue: 146(18), P. 1357 - 1366

Published: Oct. 19, 2022

Background: This study was conducted to determine the effect of hypothermic temperature control after in-hospital cardiac arrest (IHCA) on mortality and functional outcome as compared with normothermia. Methods: An investigator initiated, open-label, blinded-outcome-assessor, multicenter, randomized controlled trial comparing (32-34°C) for 24 h normothermia IHCA in 11 hospitals Germany. The primary endpoint all-cause 180 days. Secondary end points included favorable using Cerebral Performance Category scale A score 1 or 2 defined a outcome. Results: total 1055 patients were screened eligibility 249 randomized: 126 assigned 123 mean age cohort 72.6±10.4 years, 64% (152 236) male, 73% (166 227) arrests witnessed, 25% (57 231) had an initial shockable rhythm, time return spontaneous circulation 16.4±10.5 minutes. Target reached within 4.2±2.8 hours randomization group 48 at 37.0°±0.9°C group. Mortality by day 72.5% (87 120) arm, 71.2% (84 118) (relative risk, 1.03 [95% CI, 0.79–1.40]; P =0.822). In-hospital 62.5% (75 57.6% (68 1.11 0.86–1.46, =0.443). Favorable (Cerebral 2) 22.5% (27 control, 23.7% (28 1.04 0.78–1.44]; prematurely terminated because futility. Conclusions: Hypothermic did not improve survival nor presenting coma IHCA. HACA (Hypothermia After Cardiac Arrest in-hospital) underpowered may have failed detect clinically important differences between Registration: URL: https://www.clinicaltrials.gov ; Unique Identifier: NCT00457431.

Language: Английский

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Post-Cardiac Arrest: Mechanisms, Management, and Future Perspectives

Journal of Clinical Medicine, Journal Year: 2022, Volume and Issue: 12(1), P. 259 - 259

Published: Dec. 29, 2022

Cardiac arrest is an important public health issue, with a survival rate of approximately 15 to 22%. A great proportion these deaths occur after resuscitation due post-cardiac syndrome, which characterized by the ischemia-reperfusion injury that affects role body. Understanding physiopathology mandatory discover new treatment strategies and obtain better results. Besides improvements in cardiopulmonary maneuvers, increase rates observed recent decades approaches care. In this review, we will discuss physiopathology, etiologies, post-resuscitation care, emphasizing targeted temperature management, early coronary angiography, rehabilitation.

Language: Английский

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Hypothermia for neuroprotection in adults after cardiac arrest

Cochrane library, Journal Year: 2023, Volume and Issue: 2023(6)

Published: May 22, 2023

Language: Английский

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Temperature Management for Comatose Adult Survivors of Cardiac Arrest: A Science Advisory From the American Heart Association

Circulation, Journal Year: 2023, Volume and Issue: 148(12), P. 982 - 988

Published: Aug. 16, 2023

Targeted temperature management has been a cornerstone of post-cardiac arrest care for patients remaining unresponsive after return spontaneous circulation since the initial trials in 2002 found that mild therapeutic hypothermia improves neurological outcome. The suggested range expanded 2015 response to large trial finding outcomes were not better with treatment at 33° C compared 36° C. In 2021, another was published which control than those treated strategy strict normothermia. On basis these new data, International Liaison Committee on Resuscitation and other organizations have altered their recommendations cardiac arrest. American Heart Association guidelines this topic will be introduced 2023 focused update. To provide guidance clinicians while update is forthcoming, Association's Emergency Cardiovascular Care convened writing group review TTM2 (Hypothermia Versus Normothermia After Out-of-Hospital Cardiac Arrest) context recent evidence present an opinion how may influence clinical practice. This science advisory informed by trial, consideration influential studies, discussion between experts fields cardiology, critical care, emergency medicine, neurology. Conclusions presented statement do replace current but are intended expert novel literature incorporated into future suggest opportunity reassessment

Language: Английский

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Clinical targeting of the cerebral oxygen cascade to improve brain oxygenation in patients with hypoxic–ischaemic brain injury after cardiac arrest

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

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Targeted temperature control following traumatic brain injury: ESICM/NACCS best practice consensus recommendations

Critical Care, Journal Year: 2024, Volume and Issue: 28(1)

Published: May 20, 2024

The aim of this panel was to develop consensus recommendations on targeted temperature control (TTC) in patients with severe traumatic brain injury (TBI) and moderate TBI who deteriorate require admission the intensive care unit for intracranial pressure (ICP) management.

Language: Английский

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Machine learning derivation of two cardiac arrest subphenotypes with distinct responses to treatment

Journal of Translational Medicine, Journal Year: 2025, Volume and Issue: 23(1)

Published: Jan. 6, 2025

Cardiac arrest (CA), characterized by its heterogeneity, poses challenges in patient management. This study aimed to identify clinical subphenotypes CA patients aid classification, prognosis assessment, and treatment decision-making. For this study, comprehensive data were extracted from the Medical Information Mart for Intensive Care IV (MIMIC-IV) 2.0 database. We excluded under 18 years old, those not initially admitted intensive care unit (ICU), or treated ICU less than 72 h. A total of 57 parameters relevant selected analysis. These included demographic data, vital signs, laboratory parameters. After an extensive literature review expert consultations, key factors such as temperature (T), sodium (Na), creatinine (CR), glucose (GLU), heart rate (HR), PaO2/FiO2 ratio (P/F), hemoglobin (HB), mean arterial pressure (MAP), platelets (PLT), white blood cell count (WBC) identified most significant cluster Consensus analysis was utilized examine values these routine within first 24 h post-ICU admission categorize classes. Furthermore, in-hospital 28-day mortality rates across different assessed using multivariate logistic Cox regression applying exclusion criteria, 719 with a median age 67.22 (IQR: 55.50-79.34), whom 63.28% male. The delineated two distinct subphenotypes: Subphenotype 1 (SP1) 2 (SP2). Compared SP1, SP2 exhibited significantly higher levels P/F, HB, MAP, PLT, Na, but lower T, HR, GLU, WBC, CR. had notably compared SP1 (53.01% vs. 39.36% P < 0.001). decreased continuously both subphenotypes, more rapid decline SP2. differences remained after adjusting potential covariates (adjusted OR = 1.82, 95% CI: 1.26–2.64, 0.002; HR 1.84, 1.40–2.41, successfully analyzing following admission. when differentiation could play crucial role tailoring care, assessing prognosis, guiding targeted strategies patients.

Language: Английский

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Prognostication after cardiac arrest: how EEG and evoked potentials may improve the challenge

Annals of Intensive Care, Journal Year: 2022, Volume and Issue: 12(1)

Published: Dec. 8, 2022

About 80% of patients resuscitated from CA are comatose at ICU admission and nearly 50% survivors still unawake 72 h. Predicting neurological outcome these is important to provide correct information patient's relatives, avoid disproportionate care in with irreversible hypoxic-ischemic brain injury (HIBI) inappropriate withdrawal a possible favorable recovery. ERC/ESICM 2021 algorithm allows classification as "poor likely" 32%, the remaining "indeterminate" 68%. The crucial question know how we could improve assessment both unfavorable but also prediction. Neurophysiological tests, i.e., electroencephalography (EEG) evoked-potentials (EPs) non-invasive bedside investigations. EEG record electrical fields, characterized by high temporal resolution low spatial resolution. largely available, represented most widely tool use recent survey examining current neuro-prognostication practices. severity HIBI correlated predominant frequency background continuity leading "highly malignant" patterns suppression or burst severe HIBI. EPs differ signals they stimulus induced represent summated activities large populations neurons firing synchrony, requiring average numerous stimulations. Different (i.e., somato sensory (SSEPs), brainstem auditory (BAEPs), middle latency (MLAEPs) long event-related potentials (ERPs) mismatch negativity (MMN) P300 responses) can be assessed ICU, different generators prognostic values. In present review, summarize signal generators, recording modalities, interpretation values neurophysiological tools. Finally, assess perspective for futures investigations, aiming reduce uncertainty disorders consciousness (DoC) after CA.

Language: Английский

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