Neurologic Complications of Critical Medical Illness DOI
Nicholas A. Morris, Aarti Sarwal

CONTINUUM Lifelong Learning in Neurology, Journal Year: 2023, Volume and Issue: 29(3), P. 848 - 886

Published: June 1, 2023

ABSTRACT Objective This article reviews the neurologic complications encountered in patients admitted to non-neurologic intensive care units, outlines various scenarios which a consultation can add diagnosis or management of critically ill patient, and provides advice on best diagnostic approach evaluation these patients. Latest Developments Increasing recognition their adverse impact long-term outcomes has led increased neurology involvement units. The COVID-19 pandemic highlighted importance having structured clinical critical illness as well with chronic disabilities. Essential Points Critical is often accompanied by complications. Neurologists need be aware unique needs patients, especially nuances examination, challenges testing, neuropharmacologic aspects commonly used medications.

Language: Английский

2023 ESC Guidelines for the management of acute coronary syndromes DOI Open Access
Robert A. Byrne, Xavier Rosselló, J J Coughlan

et al.

European Heart Journal, Journal Year: 2023, Volume and Issue: 44(38), P. 3720 - 3826

Published: Aug. 25, 2023

Language: Английский

Citations

1904
2023 ESC Guidelines for the management of acute coronary syndromes DOI Open Access
Robert A. Byrne, Xavier Rosselló, J J Coughlan

et al.

European Heart Journal Acute Cardiovascular Care, Journal Year: 2023, Volume and Issue: 13(1), P. 55 - 161

Published: Sept. 22, 2023

Journal Article Corrected proof Guidelines 2023 ESC for the management of acute coronary syndromes: Developed by task force on syndromes European Society Cardiology (ESC) Get access Robert A Byrne, Byrne (Ireland) Corresponding authors: A. Department and Cardiovascular Research Institute (CVRI) Dublin, Mater Private Network, Ireland, School Pharmacy Biomolecular Sciences, RCSI University Medicine Health Ireland. Tel: +353-1-2483190, E-mail: [email protected] https://orcid.org/0000-0001-5224-6393 Search other works this author on: Oxford Academic Google Scholar Xavier Rossello, Rossello (Spain) https://orcid.org/0000-0001-6783-8463 J Coughlan, Coughlan https://orcid.org/0000-0001-6086-3279 Emanuele Barbato, Barbato (Italy) https://orcid.org/0000-0002-0050-5178 Colin Berry, Berry (United Kingdom) https://orcid.org/0000-0002-4547-8636 Alaide Chieffo, Chieffo https://orcid.org/0000-0002-3505-9112 Marc Claeys, Claeys (Belgium) https://orcid.org/0000-0002-6628-9543 Gheorghe-Andrei Dan, Dan (Romania) https://orcid.org/0000-0001-9867-2582 R Dweck, Dweck https://orcid.org/0000-0001-9847-5917 Mary Galbraith, Galbraith https://orcid.org/0000-0002-4196-1815 ... Show more Martine Gilard, Gilard (France) Lynne Hinterbuchner, Hinterbuchner (Austria) https://orcid.org/0000-0001-5369-7399 Ewa Jankowska, Jankowska (Poland) https://orcid.org/0000-0002-9202-432X Peter Jüni, Jüni Takeshi Kimura, Kimura (Japan) Vijay Kunadian, Kunadian https://orcid.org/0000-0003-2975-6971 Margret Leosdottir, Leosdottir (Sweden) https://orcid.org/0000-0003-1677-1566 Roberto Lorusso, Lorusso (Netherlands) https://orcid.org/0000-0002-1777-2045 F E Pedretti, Pedretti https://orcid.org/0000-0003-1789-8657 Angelos G Rigopoulos, Rigopoulos (Greece) https://orcid.org/0000-0003-0735-2319 Maria Rubini Gimenez, Gimenez (Germany) https://orcid.org/0000-0003-2384-8250 Holger Thiele, Thiele Pascal Vranckx, Vranckx Sven Wassmann, Wassmann Nanette Kass Wenger, Wenger States America) Borja Ibanez, Ibanez Clinical Department, Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain, IIS-Fundación Jiménez Díaz Hospital, CIBERCV, ISCIII, Spain. +3491 4531200, [email protected] https://orcid.org/0000-0002-5036-254X Scientific Document Group Heart Journal. Acute Care, zuad107, https://doi.org/10.1093/ehjacc/zuad107 Published: 22 September history typeset:

Language: Английский

Citations

183
Hypothermia for neuroprotection in adults after cardiac arrest DOI
Jasmin Arrich,

Nikola Schütz,

Julia Oppenauer

et al.

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

Published: May 22, 2023

Language: Английский

Citations

35
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
Temperature control after adult cardiac arrest: An updated systematic review and meta-analysis DOI Creative Commons
Asger Granfeldt, Mathias J. Holmberg, Jerry P. Nolan

et al.

Resuscitation, Journal Year: 2023, Volume and Issue: 191, P. 109928 - 109928

Published: Aug. 7, 2023

To perform an updated systematic review and meta-analysis on temperature control in adult patients with cardiac arrest.The is update of a previous published 2021. An search including PubMed, Embase, the Cochrane Central Register Controlled Trials was performed May 31, 2023. trials humans were included. The population included arrest. all aspects timing, temperature, duration, method induction maintenance, rewarming. Two investigators reviewed for relevance, extracted data, assessed risk bias. Data pooled using random-effects models. Certainty evidence evaluated GRADE.The identified six new trials. Risk bias as intermediate most outcomes. For target 32-34 °C vs. normothermia or 36 °C, two identified, seven meta-analysis. Temperature did not result improvement survival (risk ratio: 1.06 [95%CI: 0.91, 1.23]) favorable neurological outcome 1.27 0.89, 1.81]) at 90-180 days after arrest (low certainty evidence). Subgroup analysis according to location (in-hospital out-of-hospital) found similar results. A sensitivity nine comparing any time point also show outcomes 1.14 [95%CI 0.98, 1.34]). New individual 31-34 12-24 hours hours, rewarming rate 0.25-0.5 °C/hour, effect fever prevention no differences outcomes.This showed benefit compared although 95% confidence intervals cannot rule out potential beneficial effect. Important knowledge gaps exist topics such hypothermic targets, rate, control.

Language: Английский

Citations

20
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
2024 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

Robert Greif,

Janet Bray, Therese Djärv

et al.

Resuscitation, Journal Year: 2024, Volume and Issue: unknown, P. 110414 - 110414

Published: Nov. 1, 2024

Language: Английский

Citations

8
Temperature control after cardiac arrest DOI Creative Commons
Claudio Sandroni, Daniele Natalini, Jerry P. Nolan

et al.

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

Published: Nov. 24, 2022

Abstract Most of the patients who die after cardiac arrest do so because hypoxic-ischemic brain injury (HIBI). Experimental evidence shows that temperature control targeted at hypothermia mitigates HIBI. In 2002, one randomized trial and quasi-randomized showed 32–34 °C improved neurological outcome mortality in are comatose arrest. However, following publication these trials, other studies have questioned neuroprotective effects hypothermia. 2021, largest study conducted far on (the TTM-2 trial) including 1900 adults resuscitation no effect 33 compared with normothermia or fever control. A systematic review 32 trials published between 2001 2021 concluded a target prevention did not result an improvement survival (RR 1.08; 95% CI 0.89–1.30) favorable functional 1.21; 0.91–1.61) 90–180 days resuscitation. There was substantial heterogeneity across certainty low. Based results, International Liaison Committee Resuscitation currently recommends monitoring core actively preventing (37.7 °C) for least 72 h from Future needed to identify potential patient subgroups may benefit aimed comparing

Language: Английский

Citations

25
Post-Cardiac Arrest Syndrome DOI Open Access
James Penketh, Jerry P. Nolan

Journal of Neurosurgical Anesthesiology, Journal Year: 2023, Volume and Issue: 35(3), P. 260 - 264

Published: May 16, 2023

Post-cardiac arrest syndrome (PCAS) is a multicomponent entity affecting many who survive an initial period of resuscitation following cardiac arrest. This focussed review explores some the strategies for mitigating effects PCAS return spontaneous circulation. We consider current evidence controlled oxygenation, blood-pressure targets, timing coronary reperfusion, and temperature control treatment seizures. Despite several large trials investigating specific to improve outcomes after arrest, questions remain unanswered. Results studies suggest that interventions may benefit subgroups patients, but optimal duration unknown. The role intracranial pressure monitoring has been subject only few studies, its benefits unclear. Research aimed at improving management ongoing.

Language: Английский

Citations

13