Can serum markers of brain injury predict good neurological outcome after out‑of‑hospital cardiac arrest?

2021 ◽  
Author(s):  
Weiwei Li ◽  
Jing Wang
Keyword(s):  
Cardiac Arrest ◽  
Brain Injury ◽  
Neurological Outcome ◽  
Serum Markers ◽  
Good Neurological Outcome ◽  
Hospital Cardiac Arrest

scholarly journals Serum markers of brain injury can predict good neurological outcome after out-of-hospital cardiac arrest

2021 ◽  
Vol 47 (9) ◽  
pp. 984-994 ◽  
Author(s):  
Marion Moseby-Knappe ◽  
Niklas Mattsson-Carlgren ◽  
Pascal Stammet ◽  
Sofia Backman ◽  
Kaj Blennow ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Brain Injury ◽  
Neurological Outcome ◽  
Serum Markers ◽  
Good Neurological Outcome ◽  
Hospital Cardiac Arrest

scholarly journals Mechanical circulatory support for refractory out-of-hospital cardiac arrest: a Danish nationwide multicenter study

Critical Care ◽  
2021 ◽  
Vol 25 (1) ◽  
Author(s):  
Sivagowry Rasalingam Mørk ◽  
Carsten Stengaard ◽  
Louise Linde ◽  
Jacob Eifer Møller ◽  
Lisette Okkels Jensen ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Cardiac Arrest ◽  
Survival Rate ◽  
Neurological Outcome ◽  
Mechanical Circulatory Support ◽  
Circulatory Support ◽  
Good Neurological Outcome ◽  
Factors Associated ◽  
National Consensus ◽  
Hospital Cardiac Arrest

Abstract Background Mechanical circulatory support (MCS) with either extracorporeal membrane oxygenation or Impella has shown potential as a salvage therapy for patients with refractory out-of-hospital cardiac arrest (OHCA). The objective of this study was to describe the gradual implementation, survival and adherence to the national consensus with respect to use of MCS for OHCA in Denmark, and to identify factors associated with outcome. Methods This retrospective, observational cohort study included patients receiving MCS for OHCA at all tertiary cardiac arrest centers (n = 4) in Denmark between July 2011 and December 2020. Logistic regression and Kaplan–Meier survival analysis were used to determine association with outcome. Outcome was presented as survival to hospital discharge with good neurological outcome, 30-day survival and predictors of 30-day mortality. Results A total of 259 patients were included in the study. Thirty-day survival was 26%. Sixty-five (25%) survived to hospital discharge and a good neurological outcome (Glasgow–Pittsburgh Cerebral Performance Categories 1–2) was observed in 94% of these patients. Strict adherence to the national consensus showed a 30-day survival rate of 30% compared with 22% in patients violating one or more criteria. Adding criteria to the national consensus such as signs of life during cardiopulmonary resuscitation (CPR), pre-hospital low-flow < 100 min, pH > 6.8 and lactate < 15 mmol/L increased the survival rate to 48%, but would exclude 58% of the survivors from the current cohort. Logistic regression identified asystole (RR 1.36, 95% CI 1.18–1.57), pulseless electrical activity (RR 1.20, 95% CI 1.03–1.41), initial pH < 6.8 (RR 1.28, 95% CI 1.12–1.46) and lactate levels > 15 mmol/L (RR 1.16, 95% CI 1.16–1.53) as factors associated with increased risk of 30-day mortality. Patients presenting signs of life during CPR had reduced risk of 30-day mortality (RR 0.63, 95% CI 0.52–0.76). Conclusions A high survival rate with a good neurological outcome was observed in this Danish population of patients treated with MCS for OHCA. Stringent patient selection for MCS may produce higher survival rates but potentially withholds life-saving treatment in a significant proportion of survivors.

Abstract T P295: Neurological Recovery Following Out-of-hospital Cardiac Arrest: Role of Hypothermia

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
I-Chen Yu ◽  
Nathan Schleinkofer ◽  
Joo-Young Maeng ◽  
Yu-Chieh Chen ◽  
Riddhi Doshi ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Brain Injury ◽  
Neurological Outcome ◽  
The United States ◽  
Neurological Function ◽  
Neuroprotective Strategies ◽  
Included Review ◽  
Initial Rhythm ◽  
Hospital Cardiac Arrest

Introduction: Every year about 70% of coronary heart disease deaths in the United States occur out of hospital, usually presenting as ‘sudden death’ due to cardiac arrest. Despite the improvement of survival with advanced cardiac interventions, mortality remains high. Therapeutic hypothermia (TH) has been shown to be neuroprotective after cardiac arrest. We explored factors associated with good recovery of neurological function following out-of-hospital cardiac arrest (OHCA). Methods: This retrospective study included review of electronic medical records from a major healthcare system in Northeast Indiana. Individuals who suffered OHCA from January 2011 to June 2014 were included. Neurological function was evaluated by Modified Rankin Scale (mRS) at discharge. The neurological outcome was defined as good (mRS 0-3), poor (mRS 4-5), and deceased (mRS 6) to assess the association of examined variables. Results: Among the 111 patients meeting inclusion criteria, the mortality at discharge was 68.6% in TH-treated patients and 84% in normothermia patients. For almost half (47.5%) of the patients undergoing TH who died prior to discharge, brain-related causes were the primary cause of death. 21 patients who had imaging or pathological examinations all showed evidences of ischemic brain injury. Among TH-treated survivors, patients with return of spontaneous cardiac rhythm (ROSC) within 20 minutes of onset were 1.4 times the odds more likely to have a good neurological outcome at discharge (p=0.02). Patients with ventricular fibrillation had 2 times the odds more likely retaining good neurological function at discharge after receiving TH treatment (p=0.012). The time to initiate TH (mean 2.3 ± 1.5 hours) and time to reach target temperature (mean 7.2 ± 2.3 hours) were not associated with neurological outcome at discharge. Conclusions: Initial rhythm and time to ROSC were identified as reliable predictors of good neurological function following OHCA. TH has been found to be insufficient in preventing brain injury. This study emphasizes the need for future studies to develop new neuroprotective strategies to improve survival among OHCA patients.

P1706Neurological outcome in patients with out-of-hospital cardiac arrest undergoing a standardised protocol including therapeutic hypothermia and routine coronary angiography

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
M Akin ◽  
V Garcheva ◽  
J T Sieweke ◽  
J Tongers ◽  
L C Napp ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Coronary Angiography ◽  
Therapeutic Hypothermia ◽  
Neurological Outcome ◽  
Life Support ◽  
Neuron Specific Enolase ◽  
Good Neurological Outcome ◽  
Male Predominance ◽  
S 100 ◽  
Hospital Cardiac Arrest

Abstract Purpose To establish cut-offs for neuromarkers such as neuron-specific enolase (NSE) and S-100 predicting good neurological outcome for patients treated with therapeutic hypothermia with out-of-hospital cardiac arrest (OHCA) and return of spontaneous circulation (ROSC) as current cut-offs had been derived from normothermic cohorts. Methods Consecutive data of all patients with OHCA admitted to our institution between 01/2011 and 12/2016 were collected in a database. Patient received standard intensive care according to the Hannover Cardiac Resuscitation Algorithm (HaCRA) including mandatory hypothermia. Neurological markers such as neuron-specific enolase (NSE) and S-100 have been used to assess neurological damage following OHCA. Results Mean age of overall patient population (n=302) was 63±14 [54–74] years with a male predominance (77%). Cardiac arrest was witnessed in 81% and bystander cardiopulmonal resuscitation (CPR) was performed in 67%. Initial rhythm was ventricular fibrillation in 69%. ROSC had been achieved after 24±17 minutes. Hypothermia was applied in all patients. In 95% percutaneous coronary angiography and in 57% of them coronary intervention was performed. After ROSC, STEMI was present in 44%. Mechanical support was required in 19%. 30 day mortality was 44% in the total cohort. Mean NSE was 27±69 μg/l, mean NSE with good neurological outcome was 20±8.7 μg/l, highest NSE with good neurological outcome was 46 μg/l. Mean S-100 was 0.114±2.037μg/l, mean S-100 with good neurological outcome was 0.068±0.067 μg/l, highest S-100 with good neurological outcome was 0.360 μg/l. Conclusion Even when using a strict protocol for OHCA patients and routinely applying therapeutic hypothermia, the cut-offs for NSE and S-100 regarding good neurological outcome are similar to those reported before without therapeutic hypothermia, but they must not be used solitary to withdraw life support as even very high markers can be associated with goof neurological outcome in individual patients.

scholarly journals The association between post resuscitation hemoglobin level and survival with good neurological outcome following Out Of Hospital cardiac arrest

Resuscitation ◽  
2016 ◽  
Vol 99 ◽  
pp. 7-12 ◽  
Author(s):  
Aiham Albaeni ◽  
Shaker M. Eid ◽  
Bolanle Akinyele ◽  
Lekshmi Narayan Kurup ◽  
Dhananjay Vaidya ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Neurological Outcome ◽  
Hemoglobin Level ◽  
Good Neurological Outcome ◽  
Hospital Cardiac Arrest

Abstract 31: Low versus High Blood Pressure Targets After Out-Of-Hospital Cardiac Arrest

Circulation ◽  
2019 ◽  
Vol 140 (Suppl_2) ◽  
Author(s):  
Pekka Jakkula ◽  
Koen Ameloot ◽  
Cathy De Deyne ◽  
Jo Dens ◽  
Matti Reinikainen ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Cardiac Arrest ◽  
Brain Injury ◽  
Neurological Outcome ◽  
Neuron Specific Enolase ◽  
Cerebral Hypoperfusion ◽  
Chronic Hypertension ◽  
Blood Pressure Targets ◽  
Significant Difference ◽  
Hospital Cardiac Arrest

Introduction: The optimal level of blood pressure after out-of-hospital cardiac arrest (OHCA) is unknown. Hypotension may aggravate cerebral hypoperfusion exacerbating the post-anoxic brain injury. On the other hand, excessive vasopressor support may increase myocardial oxygen consumption and induce arrhythmias. We aimed to evaluate the effects of different blood pressure targets on the extent of brain injury and neurological outcome in patients resuscitated from OHCA. Methods: We performed a pooled post hoc analysis of OHCA patients randomised in the Neuroprotect (NCT02541591) and COMACARE (NCT02698917) trials to either mean arterial pressure (MAP) 65 mmHg or 80/85-100 mmHg targets for the first 36 h after ICU admission. We compared the serum neuron-specific enolase (NSE) concentrations between the groups at 24, 48 and 72 h after cardiac arrest and the neurological outcome according to the Cereberal Performance Category (CPC) scale at 6 months. We defined CPC 1-2 as good outcome and CPC 3-5 as poor outcome. In addition, we conducted a two-way analysis of variance to assess the effects of the MAP target and previous chronic hypertension on NSE concentrations. Results: All 224 patients included in the original studies were included in the analysis. Of these, 111 patients were randomised to the MAP 80/85-100 mmHg group and 113 patients to the MAP 65 mmHg group. Patients assigned to the higher MAP target had significantly higher blood pressure levels (p<0.001). We did not find any statistically significant difference in NSE concentrations (Figure 1) or good neurological outcome (50% in the lower MAP group vs. 56% in the higher MAP group, p=0.417) between the intervention groups. We did not observe statistically significant interaction between the MAP target and chronic hypertension for NSE (p=0.437). Conclusion: Targeting MAP 65 mmHg vs. MAP 80/85-100 mmHg after OHCA did not affect the extent of brain injury as determined by NSE concentration or neurological outcome at 6 months.

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