Oxygen Targets in Comatose Survivors of Cardiac Arrest

New England Journal of Medicine, Год журнала: 2022, Номер 387(16), С. 1467 - 1476

Опубликована: Авг. 27, 2022

The appropriate oxygenation target for mechanical ventilation in comatose survivors of out-of-hospital cardiac arrest is unknown.In this randomized trial with a 2-by-2 factorial design, we randomly assigned adults 1:1 ratio to either restrictive oxygen partial pressure arterial (Pao2) 9 10 kPa (68 75 mm Hg) or liberal Pao2 13 14 (98 105 Hg); patients were also one two blood-pressure targets (reported separately). primary outcome was composite death from any cause hospital discharge severe disability coma (Cerebral Performance Category [CPC] 3 4; categories range 1 5, higher values indicating more disability), whichever occurred first within 90 days after randomization. Secondary outcomes neuron-specific enolase levels at 48 hours, cause, the score on Montreal Cognitive Assessment (ranging 0 30, scores better cognitive ability), modified Rankin scale 6, greater and CPC days.A total 789 underwent A primary-outcome event 126 394 (32.0%) restrictive-target group 134 395 (33.9%) liberal-target (hazard ratio, 0.95; 95% confidence interval, 0.75 1.21; P = 0.69). At days, had 113 (28.7%) 123 (31.1%) group. On CPC, median category groups; scale, 2 group; Assessment, 27 groups. level 17 μg per liter 18 incidence adverse events similar groups.Targeting strategy resuscitation resulted coma. (Funded by Novo Nordisk Foundation; BOX ClinicalTrials.gov number, NCT03141099.).

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

Intensive Care Medicine, Год журнала: 2022, Номер 48(4), С. 389 - 413

Опубликована: Март 4, 2022

To assess the ability of clinical examination, blood biomarkers, electrophysiology or neuroimaging assessed within 7 days from return spontaneous circulation (ROSC) to predict good neurological outcome, defined as no, mild, moderate disability (CPC 1–2 mRS 0–3) at discharge intensive care unit later, in comatose adult survivors cardiac arrest (CA). PubMed, EMBASE, Web Science and Cochrane Database Systematic Reviews were searched. Sensitivity specificity for outcome calculated each predictor. The risk bias was using QUIPS tool. A total 37 studies included. Due heterogeneities recording times, predictor thresholds, definition some predictors, meta-analysis not performed. withdrawal localisation motor response pain immediately 72–96 h after ROSC, normal values neuron-specific enolase (NSE) 24 h-72 a short-latency somatosensory evoked potentials (SSEPs) N20 wave amplitude > 4 µV continuous background without discharges on electroencephalogram (EEG) 72 absent diffusion restriction cortex deep grey matter MRI 2–7 ROSC predicted with more than 80% sensitivity above 40% most studies. Most had high bias. In survivors, clinical, biomarker, electrophysiology, imaging identified patients destined first week

Язык: Английский

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Effect of Lower vs Higher Oxygen Saturation Targets on Survival to Hospital Discharge Among Patients Resuscitated After Out-of-Hospital Cardiac Arrest

JAMA, Год журнала: 2022, Номер 328(18), С. 1818 - 1818

Опубликована: Окт. 26, 2022

The administration of a high fraction oxygen following return spontaneous circulation in out-of-hospital cardiac arrest may increase reperfusion brain injury.To determine whether targeting lower saturation the early phase postresuscitation care for improves survival at hospital discharge.This multicenter, parallel-group, randomized clinical trial included unconscious adults with and peripheral (Spo2) least 95% while receiving 100% oxygen. was conducted 2 emergency medical services 15 hospitals Victoria South Australia, between December 11, 2017, August 2020, data collection from ambulance records (final follow-up date, 25, 2021). enrolled 428 planned 1416 patients.Patients were by paramedics to receive titration achieve an either 90% 94% (intervention; n = 216) or 98% (standard care; 212) until arrival intensive unit.The primary outcome discharge. There 9 secondary outcomes collected, including hypoxic episodes (Spo2 <90%) prespecified serious adverse events, which hypoxia rearrest.The stopped due COVID-19 pandemic. Of patients who randomized, 425 analysis (median age, 65.5 years; 100 [23.5%] women) all completed trial. Overall, 82 214 (38.3%) intervention group survived discharge compared 101 211 (47.9%) standard (difference, -9.6% [95% CI, -18.9% -0.2%]; unadjusted odds ratio, 0.68 0.46-1.00]; P .05). collected during stay, 8 showed no significant difference. A episode prior observed 31.3% (n 67) participants 16.1% 34) 15.2% 7.2%-23.1%]; OR, 2.37 1.49-3.79]; < .001).Among achieving after arrest, 94%, 100%, admission unit did not significantly improve Although is limited termination pandemic, findings do support use target setting resuscitation arrest.ClinicalTrials.gov Identifier: NCT03138005.

Язык: Английский

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Extracorporeal cardiopulmonary resuscitation versus conventional cardiopulmonary resuscitation in adults with cardiac arrest: a comparative meta-analysis and trial sequential analysis

The Lancet Respiratory Medicine, Год журнала: 2023, Номер 11(10), С. 883 - 893

Опубликована: Май 22, 2023

Язык: Английский

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Brain energy metabolism: A roadmap for future research

Journal of Neurochemistry, Год журнала: 2024, Номер 168(5), С. 910 - 954

Опубликована: Янв. 6, 2024

Although we have learned much about how the brain fuels its functions over last decades, there remains still to discover in an organ that is so complex. This article lays out major gaps our knowledge of interrelationships between metabolism and function, including biochemical, cellular, subcellular aspects functional imaging adult brain, as well during development, aging, disease. The focus on unknowns substrates associated transporters, roles insulin lipid droplets, emerging role microglia, mysteries cofactor signaling molecule NAD

Язык: Английский

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Extracorporeal cardiopulmonary resuscitation versus conventional CPR in cardiac arrest: an updated meta-analysis and trial sequential analysis

Critical Care, Год журнала: 2024, Номер 28(1)

Опубликована: Фев. 21, 2024

Abstract Background Extracorporeal cardiopulmonary resuscitation (ECPR) may reduce mortality and improve neurological outcomes in patients with cardiac arrest. We updated our existing meta-analysis trial sequential analysis to further evaluate ECPR compared conventional CPR (CCPR). Methods searched three international databases from 1 January 2000 through November 2023, for randomised controlled trials or propensity score matched studies (PSMs) comparing CCPR both out-of-hospital arrest (OHCA) in-hospital (IHCA). conducted an random-effects meta-analysis, the primary outcome being mortality. Secondary included short- long-term favourable survival (30 days–1 year). also a required information size detect clinically relevant reduction Results 13 14 pairwise comparisons (6336 7712 CCPR) meta-analysis. was associated greater precision reducing overall (OR 0.63, 95% CI 0.50–0.79, high certainty), which concordant. The addition of recent revealed newly significant decrease OHCA 0.62, 0.45–0.84). Re-analysis secondary reaffirmed initial findings short-term up 30 days. Estimates 90-day–1-year remained unchanged. Conclusions found that reduces mortality, improves outcome, 30-day survival. additionally benefit OHCA, suggesting be considered IHCA OHCA.

Язык: Английский

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Sodium butyrate attenuates microglia-mediated neuroinflammation by modulating the TLR4/MyD88/NF-κB pathway and microbiome-gut-brain axis in cardiac arrest mice

Molecular Brain, Год журнала: 2025, Номер 18(1)

Опубликована: Фев. 17, 2025

Abstract Cardiac arrest (CA) is one of the most common illnesses worldwide. Post-CA brain injury (PCABI) a major cause death and poor recovery in CA patients current treatments are not very effective. The microbiome-gut-brain axis has been found to significantly affect ischemia injury. Furthermore, ischemic stroke patients, short-chain fatty acids (SCFA), especially sodium butyrate (SB), have observed promote neuroprotective effects by modulating inflammatory response microglial polarization cortex. However, precise mechanism SB on CA-induced remains elusive. Therefore, this research study established an oxygen–glucose deprivation reoxygenation (OGD/R) model using BV-2 HT22 cells simulate cerebral ischemia/reperfusion vitro potassium chloride-induced mouse mimic vivo. data revealed that markedly improved neurological scores reduced neuronal apoptosis. Moreover, it M1 microglia neuroinflammation mice. In addition, increased intestinal integrity alleviated systemic inflammation. 16S rDNA sequencing analysis indicated intervention mitigated gut microbiota dysbiosis SCFA depletion. It was also mice’s OGD/R-exposed BV2 had substantially levels MyD88, phosphorylated NF-κB p65, TLR4 proteins, which were after treatment. summary, can protect against ischemia–reperfusion controlling inhibit inflammation via TLR4/MyD88/NF-κB pathway.

Язык: Английский

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Neurologic Prognostication After Cardiac Arrest Using Brain Biomarkers

JAMA Neurology, Год журнала: 2022, Номер 79(4), С. 390 - 390

Опубликована: Фев. 28, 2022

Importance

Brain injury biomarkers released into circulation from the injured neurovascular unit are important prognostic tools in patients with cardiac arrest who develop hypoxic ischemic brain (HIBI) after return of spontaneous (ROSC).

Objective

To assess neuroprognostic utility bloodborne HIBI.

Data Sources

Studies electronic databases inception to September 15, 2021. These included MEDLINE, Embase, Evidence-Based Medicine Reviews, CINAHL, Cochrane Database Systematic and World Health Organization Global Library.

Study Selection

Articles this systmatic review meta-analysis were independently assessed by 2 reviewers. We studies that investigated neuron-specific enolase, S100 calcium-binding protein β, glial fibrillary acidic protein, neurofilament light, tau, or ubiquitin carboxyl hydrolase L1 aged 18 years older for neurologic prognostication. excluded did not (1) dichotomize outcome as favorable vs unfavorable, (2) specify timing blood sampling determination, (3) report diagnostic test accuracy biomarker concentration. Extraction Synthesis Data on study design, inclusion exclusion criteria, levels, accuracy, recorded. This was conducted accordance Preferred Reporting Items Reviews Meta-Analyses (PRISMA) guideline.

Main Outcomes Measures

Summary receiver operating characteristic curve analysis used calculate area under curve, sensitivity, specificity, optimal thresholds each biomarker. Risk bias concerns applicability Quality Assessment Diagnostic Accuracy (QUADAS-2) tool.

Results

identified 2953 studies, which 86 10 567 (7777 men [73.6] 2790 women [26.4]; pooled mean [SD] age, 62.8 [10.2] years) included. Biomarker at 48 hours ROSC demonstrated light had highest predictive value unfavorable outcome, an 0.92 (95% CI, 0.84-0.97). Subgroup analyses treated targeted temperature management those specifically out-of-hospital showed similar results (targeted management, [95% 0.86-0.95] arrest, 0.93 0.86-0.97]).

Conclusions Relevance

Neurofilament reflects white matter damage axonal injury, yielded predicting HIBI ROSC.

Trial Registration

PROSPERO Identifier:CRD42020157366

Язык: Английский

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

Resuscitation, Год журнала: 2022, Номер 172, С. 229 - 236

Опубликована: Фев. 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.

Язык: Английский

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