Effects of combined superoxide dismutase and deferoxamine on recovery of brainstem auditory evoked potentials and EEG after asphyxial cardiac arrest in dogs

Cerchiari, Erga; Sclabassi, R.J.; Šafář, Peter; Hoel, T.M.

doi:10.1016/0300-9572(90)90096-w

Cited by 26 publications

(9 citation statements)

References 35 publications

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“…As a diagnostic tool, however, waveform-based EEG analysis is subjective and laborious, with results depending on the interpreter's expertise (23). Previous attempts to use early quantitative EEG (qEEG) as a measure of neurological recovery after CA have utilized power spectral analysis (24). A readily translatable tool for tracking the effect of temperature on recovery of cortical electrical function has not been thoroughly elucidated.…”

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confidence: 99%

Early electrophysiologic markers predict functional outcome associated with temperature manipulation after cardiac arrest in rats

Jia

Koenig

Nickl

et al. 2008

Critical Care Medicine

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Objective-Therapeutic hypothermia after cardiac arrest improves survival and functional outcomes, whereas hyperthermia is harmful. The optimal method of tracking the effect of temperature on neurologic recovery after cardiac arrest has not been elucidated. We studied the recovery of cortical electrical function by quantitative electroencephalography after 7-min asphyxial cardiac arrest, using information quantity (IQ). Design-Laboratory investigation.Setting-University medical school and animal research facility. Subjects-A total of 28 male Wistar rats.Interventions-Using an asphyxial cardiac arrest rodent model, we tracked quantitative electroencephalography of 6-hr immediate postresuscitation hypothermia (at 33°C), normothermia (37°C), or hyperthermia (39°C) (N=8 per group). Neurological recovery was evaluated using the Neurological Deficit Score. Four rats were included as a sham control group. Measurements and MainResults-Greater recovery of IQ was found in rats treated with hypothermia (IQ=0.74), compared to normothermia (IQ=0.60) and hyperthermia (IQ=0.56) (p<. 001). Analysis at different intervals demonstrated a significant separation of IQ scores among the temperature groups within the first 2 hrs postresuscitation (p<.01). IQ values of >0.523 at 60 mins postresuscitation predicted good neurological outcome (72-hr Neurological Deficit Score of≥60) with a specificity of 100% and sensitivity of 81.8%. IQ was also significantly lower in rats that died prematurely compared to survivors (p<.001). IQ values correlated strongly with 72-hr Neurological Deficit Score as early as 30 mins post-cardiac arrest (Pearson correlation 0.735, p<.01) and maintained a significant association throughout the 72-hr experiment. No IQ difference was noted in sham rats with temperature manipulation. Approximately 164,600 cardiac arrests (CAs) occur in the United States each year (1). Among initial survivors, 80% remain comatose after resuscitation (2) and neurological complications represent the leading cause of disability (3,4). The ischemic brain is sensitive to temperature, such that small differences can critically influence neuropathological outcomes (5). Hyperthermia has been demonstrated to worsen ischemic outcome and is associated with increased brain injury in animal models (5,6) and clinical studies (7-9). On the other hand, induced hypothermia to 32-34°C is recommended for comatose survivors of CA (10,11) and was recently shown to significantly mitigate brain injury in animal models (12)(13)(14) and clinical trials (15-18). NIH Public AccessNeurological monitoring of comatose CA survivors is complicated by the requirement for sedative and paralytic agents, particularly in patients who are treated with hypothermia. Comatose CA survivors are typically cared for by nurses and physicians in general or cardiac intensive care units with little specialized training in neurological examination. In addition, the ability to detect even major changes in brain function in comatose patients is limited. Electroencephalograp...

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Early electrophysiologic markers predict functional outcome associated with temperature manipulation after cardiac arrest in rats

Jia

Koenig

Nickl

et al. 2008

Critical Care Medicine

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“…Reperfusion ('low-flow' phase of CA), generates a burst of radical oxygen species production [3,16-18]. A number of animal studies have explored the role of radical oxygen species in organ damage after CA [19,20]. Other studies revealed that oxidative stress increased quickly after CA, peaked during early reperfusion and subsided rapidly, suggesting that oxidant injury contributes widely to the lesions observed after CA [21,22].…”

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Plasma thioredoxin levels during post-cardiac arrest syndrome: relationship with severity and outcome

et al. 2013

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IntroductionDespite experimental evidence, clinical demonstration of acute state of oxidative stress and inflammation during post-cardiac arrest syndrome is lacking. Plasma level of thioredoxin (TRX), a redox-active protein induced under conditions of oxidative stress and inflammation, is increased in various critical care conditions. We determined plasma TRX concentrations after cardiac arrest and assessed relationships with severity and outcome.MethodsRetrospective study of consecutive patients admitted to a single academic intensive care unit (ICU) for out-of-hospital cardiac arrest (between July 2006 and March 2008). Plasma levels of TRX were measured at admission, day (D) 1, 2 and 3.ResultsOf 176 patients included, median TRX values measured in ICU survivors and non-survivors were, respectively: 22 ng/mL (7.8 to 77) vs. 72.4 (21.9 to 117.9) at admission (P < 0.001); 5.9 (3.5 to 25.5) vs. 23.2 (5.8 to 81.4) at D1 (P = 0.003); 10.8 (3.6 to 50.8) vs. 11.7 (4.5 to 66.4) at D2 (P = 0.22); and 16.7 (5.3 to 68.3) vs. 17 (4.3 to 62.9) at D3 (P = 0.96). Patients dying within 24 hours had significantly (P < 0.001) higher TRX levels (118.6 ng/mL (94.8 to 280)) than those who died after 24 hours or survived (50.8 (13.9 to 95.7) and 22 (7.8 to 77)). The area under the ROC curve to predict early death was 0.84 (0.76 to 0.91).TRX levels on admission were significantly correlated with 'low-flow' duration (P = 0.003), sequential organ failure assessment (SOFA) score (P < 0.001), and blood lactate concentration (P < 0.001), but not with 'no-flow' duration or simplified acute physiology score (SAPS) II score. TRX levels and admission arterial pO2 correlated negatively (r = -0.17, P = 0.03). Finally, cardiac arrest with cardiac etiology exhibited lower levels of TRX than in cases of extra-cardiac cause (46 ng/mL (11 to 104) vs. 68 (42 to 137), P = 0.01).ConclusionsOur data show for the first time that TRX levels were elevated early following cardiac arrest, suggestive of oxidative stress and inflammation occurring with this condition. Highest values were found in the most severe patients. TRX could be a useful tool for further exploration and comprehension of post-cardiac arrest syndrome.

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“…It is not until 3 days after ROSC that lack of PLR and absence of motor response to a painful stimulus predict reliably that a human patient will fail to regain consciousness. 106,107 Elevations of neuronspecific enolase (NSE) levels in cerebrospinal fluid (CSF) or plasma, a commonly used biomarker of neuronal injury after CPA, were found to imply poor neurologic outcome in experimental animal and clinical human studies, but the assay is not available for clinical veterinary use at this time. 105 Even though no comparable data are available for veterinary patients, the notion that early clinical prognostication of the final neurologic outcome is unreliable is likely true in dogs and cats also.…”

Section: Neurologic Assessment and Prognosticationmentioning

confidence: 99%

Post–Cardiac Arrest Care

Boller¹,

Fletcher²

2015

Small Animal Critical Care Medicine

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Effects of combined superoxide dismutase and deferoxamine on recovery of brainstem auditory evoked potentials and EEG after asphyxial cardiac arrest in dogs

Cited by 26 publications

References 35 publications

Early electrophysiologic markers predict functional outcome associated with temperature manipulation after cardiac arrest in rats

Early electrophysiologic markers predict functional outcome associated with temperature manipulation after cardiac arrest in rats

Plasma thioredoxin levels during post-cardiac arrest syndrome: relationship with severity and outcome

Post–Cardiac Arrest Care

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