Brain injury after cardiac arrest: pathophysiology, treatment, and prognosis

Intensive Care Medicine, Год журнала: 2021, Номер 47(12), С. 1393 - 1414

Опубликована: Окт. 27, 2021

Post-cardiac arrest brain injury (PCABI) is caused by initial ischaemia and subsequent reperfusion of the following resuscitation. In those who are admitted to intensive care unit after cardiac arrest, PCABI manifests as coma, main cause mortality long-term disability. This review describes mechanisms PCABI, its treatment options, outcomes, suggested strategies for outcome prediction.

Язык: Английский

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Prediction of poor neurological outcome in comatose survivors of cardiac arrest: a systematic review

Intensive Care Medicine, Год журнала: 2020, Номер 46(10), С. 1803 - 1851

Опубликована: Сен. 11, 2020

To assess the ability of clinical examination, blood biomarkers, electrophysiology, or neuroimaging assessed within 7 days from return spontaneous circulation (ROSC) to predict poor neurological outcome, defined as death, vegetative state, severe disability (CPC 3-5) at hospital discharge/1 month later, in comatose adult survivors cardiac arrest (CA).PubMed, EMBASE, Web Science, and Cochrane Database Systematic Reviews (January 2013-April 2020) were searched. Sensitivity false-positive rate (FPR) for each predictor calculated. Due heterogeneities recording times, thresholds, definition some predictors, meta-analysis was not performed.Ninety-four studies (30,200 patients) included. Bilaterally absent pupillary corneal reflexes after day 4 ROSC, high values neuron-specific enolase 24 h N20 waves short-latency somatosensory-evoked potentials (SSEPs) unequivocal seizures on electroencephalogram (EEG) EEG background suppression burst-suppression diffuse cerebral oedema brain CT 2 reduced diffusion MRI 2-5 ROSC had 0% FPR outcome most studies. Risk bias using QUIPS tool all predictors.In resuscitated patients, clinical, biochemical, neurophysiological, radiological tests have a potential with no predictions first week CA. Guidelines should consider methodological concerns limited sensitivity individual modalities. (PROSPERO CRD42019141169).

Язык: Английский

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Sudden Cardiac Arrest Survivorship: A Scientific Statement From the American Heart Association

Circulation, Год журнала: 2020, Номер 141(12)

Опубликована: Фев. 12, 2020

Cardiac arrest systems of care are successfully coordinating community, emergency medical services, and hospital efforts to improve the process for patients who have had a cardiac arrest. As result, number people surviving sudden is increasing. However, physical, cognitive, emotional effects may linger months or years. Systematic recommendations stop short addressing partnerships needed caregivers after stabilization. This document expands resuscitation system include patients, caregivers, rehabilitative healthcare partnerships, which central survivorship.

Язык: Английский

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Early predictors of poor outcome after out-of-hospital cardiac arrest

Critical Care, Год журнала: 2017, Номер 21(1)

Опубликована: Апрель 13, 2017

Early identification of predictors for a poor long-term outcome in patients who survive the initial phase out-of-hospital cardiac arrest (OHCA) may facilitate future clinical research, process care and information provided to relatives. The aim this study was determine association between variables available from patient's history status at intensive admission with unconscious survivors OHCA.Using cohort Target Temperature Management trial, we performed post hoc analysis 933 OHCA presumed cause had complete 6-month follow-up. Outcomes were survival neurological function as defined by Cerebral Performance Category (CPC) scale 6 months after OHCA. After multiple imputations compensate missing data, backward stepwise multivariable logistic regression applied identify factors independently predictive (CPC 3-5). On basis these factors, risk score constructed.We identified ten independent outcome: older age, occurring home, rhythm other than ventricular fibrillation/tachycardia, longer duration no flow, low administration adrenaline, bilateral absence corneal pupillary reflexes, Glasgow Coma Scale motor response 1, lower pH partial pressure carbon dioxide arterial blood value 4.5 kPa hospital admission. A based on impact each model yielded median (range) AUC 0.842 (0.840-0.845) good calibration. Internal validation using bootstrapping corrected optimism 0.818 (0.816-0.821).Among care, They reflected pre-hospital circumstances (six variables) patient (four variables). By simple easy-to-use scoring system variables, high be early.

Язык: Английский

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Out-of-hospital cardiac arrest: prehospital management

The Lancet, Год журнала: 2018, Номер 391(10124), С. 980 - 988

Опубликована: Март 1, 2018

Язык: Английский

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Quantitative versus standard pupillary light reflex for early prognostication in comatose cardiac arrest patients: an international prospective multicenter double-blinded study

Intensive Care Medicine, Год журнала: 2018, Номер 44(12), С. 2102 - 2111

Опубликована: Ноя. 26, 2018

To assess the ability of quantitative pupillometry [using Neurological Pupil index (NPi)] to predict an unfavorable neurological outcome after cardiac arrest (CA).We performed a prospective international multicenter study (10 centers) in adult comatose CA patients. Quantitative NPi and standard manual pupillary light reflex (sPLR)-blinded clinicians assessors-were recorded parallel from day 1 3 CA. Primary endpoint was compare value versus sPLR 3-month Cerebral Performance Category (CPC), dichotomized as favorable (CPC 1-2: full recovery or moderate disability) 3-5: severe disability, vegetative state, death).At any time between 3, ≤ 2 (n = 456 patients) had 51% (95% CI 49-53) negative predictive 100% positive [PPV; 0% (0-2) false-positive rate], with (98-100) specificity 32% (27-38) sensitivity for prediction outcome. Compared NPi, significantly lower PPV (p < 0.001 at 2; p 0.06 3). The combination bilaterally absent somatosensory evoked potentials (SSEP; n 188 provided higher [58% (49-67) vs. 48% (39-57) SSEP alone], comparable [100% (94-100)].Quantitative excellent CA, no false positives, than examination. addition increased prediction, while maintaining specificity.

Язык: Английский

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Dangers of hyperoxia

Critical Care, Год журнала: 2021, Номер 25(1)

Опубликована: Дек. 19, 2021

Abstract Oxygen (O 2 ) toxicity remains a concern, particularly to the lung. This is mainly related excessive production of reactive oxygen species (ROS). Supplemental O , i.e. inspiratory concentrations (F I > 0.21 may cause hyperoxaemia (i.e. arterial (a) PO 100 mmHg) and, subsequently, hyperoxia (increased tissue concentration), thereby enhancing ROS formation. Here, we review pathophysiology and potential harms supplemental in various ICU conditions. The current evidence base suggests that PaO 300 mmHg (40 kPa) should be avoided, but it uncertain whether there an “optimal level” which vary for given clinical Since even moderately supra-physiological associated with deleterious side effects, seems advisable at present titrate maintain within normal range, avoiding both hypoxaemia excess hyperoxaemia.

Язык: Английский

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Brain injury after cardiac arrest

The Lancet, Год журнала: 2021, Номер 398(10307), С. 1269 - 1278

Опубликована: Авг. 26, 2021

Язык: Английский

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ERC-ESICM guidelines on temperature control after cardiac arrest in adults

Intensive Care Medicine, Год журнала: 2022, Номер 48(3), С. 261 - 269

Опубликована: Янв. 28, 2022

Язык: Английский

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Neurofilaments as biomarkers in neurological disorders — towards clinical application

Nature Reviews Neurology, Год журнала: 2024, Номер 20(5), С. 269 - 287

Опубликована: Апрель 12, 2024

Язык: Английский

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