The future is now: neuroprotection during cardiopulmonary resuscitation

Moore, Johanna C.; Bartos, Jason A.; Matsuura, Timothy; Yannopoulos, Demetris

doi:10.1097/mcc.0000000000000405

Cited by 13 publications

(4 citation statements)

References 78 publications

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“…Bundling them together could have the potential to bring better neurological survival after cardiac arrest. [ 23 ] The insufficiency of renal function might suggest worse outcomes for children receiving ECPR. A retrospective observational study performed by Smith et al .…”

Section: Discussionmentioning

confidence: 99%

“…Anesthetic and neuromuscular blockers were more commonly used in the surviving group, which could be related to their more extensive use in children with congenital heart disease as transitional means before operations and their potential protection of the CNS and reduction of stress reactions. [ 23 ] In multiple logistic regression analysis, several factors were identified as independent risk factors of in-hospital mortality. Myocardial stunning confirmed by ultrasonography was a strong risk factor in this study (odds ratio: 10.23, 95% confidence interval: 1.20–87.41), in keeping with a previous study by Usui et al .…”

Section: Discussionmentioning

confidence: 99%

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Extracorporeal Cardiopulmonary Resuscitation in Children of Asia Pacific

Chen¹,

Qiao²,

Ma³

et al. 2018

Chinese Medical Journal

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Background:Recent advances in extracorporeal membrane oxygenation (ECMO) have led to increasing interest in its use during cardiopulmonary resuscitation (CPR). However, decisions regarding extracorporeal CPR (ECPR) in children are difficult as a result of limited studies, especially in Asia Pacific. The objective of this study was to investigate trends in survival and demographic details for children with ECPR in Asia Pacific recorded in the Extracorporeal Life Support Organization (ELSO) registry from 1999 to 2016 and identify the risk factors associated with in-hospital mortality.Methods:The data of children younger than 18 years of age who received ECPR over the past 18 years in Asia Pacific were retrospectively analyzed. The data were extracted from the ELSO registry and divided into two 9-year groups (Group 1: 1999–2007 and Group 2: 2008–2016) to assess temporal changes using univariate analysis. Then, univariate and multiple logistic regression analyses were performed between survivors and nonsurvivors to identify factors independently associated with in-hospital mortality.Results:A total of 321 children were included in final analysis, with an overall survival rate of 50.8%. Although survival rates were similar between Group 1 and Group 2 (43.1% vs. 52.5%, χ2 = 1.67, P = 0.196), the median age (1.7 [0.3, 19.2] months for Group 1 vs. 5.6 [0.8, 64.9] months for Group 2, t = −2.93, P = 0.003) and weight (3.7 [3.0, 11.5] kg for Group 1 vs. 6.0 [3.4, 20.3] kg for Group 2, t = −3.14, P = 0.002) of children increased over time, while the proportion of congenital heart disease (75.9% for Group 1 vs. 57.8% for Group 2, χ2 = 6.52, P = 0.011) and cardiogenic shock (36.2% for Group 1 vs. 7.2% for Group 2, χ2 = 36.59, P < 0.001) decreased. Patient conditions before ECMO were worse, while ECMO complications decreased across time periods, especially renal complications. Multiple logistic regression analysis of ECMO complications showed that disseminated intravascular coagulation (DIC), myocardial stunning, and neurological complications were independently associated with increased odds of hospital mortality.Conclusions:The broader indications and decreased complication rates make EPCR to be applicated more and more extensive in children in Asia Pacific region. ECMO complications such as myocardial stunning are independently associated with decreased survival.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Extracorporeal Cardiopulmonary Resuscitation in Children of Asia Pacific

Chen¹,

Qiao²,

Ma³

et al. 2018

Chinese Medical Journal

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“…The use of intrathoracic pressure regulation, which augments the circulatory effects of the respiratory pump and enhances venous return during hypovolemia, has been shown to improve CO and cerebral perfusion (Rickards et al., 2007 ; Segal et al., 2013 ; Yannopoulos, Metzger, et al., 2006 ). Improved CBF and more favorable neurological outcomes have been observed in animal models of cardiac arrest where intrathoracic pressure regulation was employed (Debaty et al., 2015 ; Moore et al., 2017 , 2021 ). Whether the intrathoracic pressure regulation may affect CBF and possibly CA through mechanisms other than CO augmentation has not been elucidated.…”

Section: Introductionmentioning

confidence: 99%

Dynamic cerebral autoregulation is preserved during orthostasis and intrathoracic pressure regulation in healthy subjects: A pilot study

Skytioti,

Wiedmann,

Sorteberg

et al. 2024

Physiological Reports

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Resistance breathing may restore cardiac output (CO) and cerebral blood flow (CBF) during hypovolemia. We assessed CBF and cerebral autoregulation (CA) during tilt, resistance breathing, and paced breathing in 10 healthy subjects. Blood velocities in the internal carotid artery (ICA), middle cerebral arteries (MCA, four subjects), and aorta were measured by Doppler ultrasound in 30° and 60° semi‐recumbent positions. ICA blood flow and CO were calculated. Arterial blood pressure (ABP, Finometer), and end‐tidal CO2 (ETCO2) were recorded. ICA blood flow response was assessed by mixed‐models regression analysis. The synchronization index (SI) for the variable pairs ABP–ICA blood velocity, ABP–MCA velocities in 0.005–0.08 Hz frequency interval was calculated as a measure of CA. Passive tilting from 30° to 60° resulted in 12% decrease in CO (p = 0.001); ICA blood flow tended to fall (p = 0.04); Resistance breathing restored CO and ICA blood flow despite a 10% ETCO2 drop. ETCO2 and CO contributed to ICA blood flow variance (adjusted R2: 0.9, p < 0.0001). The median SI was low (<0.2) indicating intact CA, confirmed by surrogate date testing. The peak SI was transiently elevated during resistance breathing in the 60° position. Resistance breathing may transiently reduce CA efficiency. Paced breathing did not restore CO or ICA blood flow.

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“…The morbidity and mortality associated with cardiac arrest (CA) are high worldwide, and the return of spontaneous circulation (ROSC) causes severe cerebral ischemia-reperfusion injury (CIRI), which is the main cause of coma in patients with CA (1,2). Owing to the complex mechanism of CIRI, the available therapies are not ideal to promote nervous system recovery (3). Therefore, the development of new strategies for the clinical management of CIRI following CA and cardiopulmonary resuscitation (CPR) has been a challenge.…”

Section: Introductionmentioning

confidence: 99%

Calpain inhibitor MDL28170 alleviates cerebral ischemia‑reperfusion injury by suppressing inflammation and autophagy in a rat model of cardiac arrest

Wang

Shi²,

Chen³

et al. 2023

Exp Ther Med

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Cerebral ischemia-reperfusion injury (CIRI) is associated with a poor neurological prognosis in patients who have experienced cardiac arrest (CA) and cardiopulmonary resuscitation (CPR). The aim of the current study was to investigate the potential role of a calpain inhibitor in CIRI using a rat model of CA. CA was induced in adult male Sprague-Dawley rats, and MDL28170 (a calpain inhibitor) was administered to the rats within 30 min after the return of spontaneous circulation. Differences between groups were evaluated by measuring survival rate, CPR duration and neurological deficit score. Hematoxylin-eosin staining and Nissl staining were performed to assess cerebral injury, and microstructure and autophagy were assessed by transmission electron microscopy. The levels of calpain-1, calpain-2, calpastatin, interleukin (IL)-1β, tumor necrosis factor (TNF)-α, P62, beclin-1 and LC3 in the brain tissues were determined using western blotting and double immunofluorescence staining. There was no significant difference in CPR duration or survival rate among the groups. At 24 h after CPR, the CA group demonstrated damaged tissue morphology; decreased neurological deficit scores, and P62 expression; and upregulated calpain-2, IL-1βp17, TNF-α, beclin-1 and LC3 levels in the cortex. However, MDL28170 improved neuronal function and suppressed inflammation and autophagy by inhibiting calpain-2 level, but there were no differences in the calpain-1 and calpastatin levels. These results suggest that calpain-2, inflammation and autophagy are involved in CA-induced CIRI. MDL28170 inhibited calpain-2 expression, inflammation and autophagy, which suggests its potential efficacy in treating post-CA nerve damage.

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The future is now: neuroprotection during cardiopulmonary resuscitation

Abstract: Multiple promising neuroprotective therapies are being developed in animal models of cardiac arrest, and are in early stages of human trials. These therapies have the potential to be bundled together to improve rates of favorable neurological survival after cardiac arrest.

Cited by 13 publications

References 78 publications

Extracorporeal Cardiopulmonary Resuscitation in Children of Asia Pacific

Extracorporeal Cardiopulmonary Resuscitation in Children of Asia Pacific

Dynamic cerebral autoregulation is preserved during orthostasis and intrathoracic pressure regulation in healthy subjects: A pilot study

Calpain inhibitor MDL28170 alleviates cerebral ischemia‑reperfusion injury by suppressing inflammation and autophagy in a rat model of cardiac arrest

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