Duration and clinical features of cardiac arrest predict early severe cerebral edema

Introduction: Cerebral edema following cardiac arrest and cardiopulmonary resuscitation (CA/CPR) is associated with unfavorable neurologic outcome. The Na + -K + -2Cl - water cotransporter NKCC1 is suspected to be a critical mediator of edema formation after ischemia. It is reported that β1 adrenoreceptor antagonists protect neurons following brain ischemia in rodents. β1 adrenoreceptor antagonists inhibit the Na + -K + -ATPase, which can inhibit driving force of NKCC1 that theoretically reduces cerebral edema following ischemia-reperfusion injury. In this study, we examined whether landiolol, a selective β1 adrenoreceptor antagonist, attenuates cerebral edema following CA/CPR. Methods: Isoflurane-anesthetized adult male mice (C57BL/6J, 25-30g) were randomized into landiolol group or control group. After 7-min CA followed by CPR, landiolol (0.5ml, 830μg/ml) was administered by continuous infusion intravenously for 4 hours. Animals in control group were given normal saline (0.5ml) in the same manner. Twenty-four hours after CA/CPR, the brain was removed to assess brain water content using wet-to-dry method. The primary outcome was measurement of the brain water content. Heart rate and arterial blood pressure were recorded. Measured parameters were analyzed by one-way ANOVA with post hoc Tukey-Kramer test using SPSS® statistics 25. Differences were considered statistically significant at a P value < 0.05. Results: Brain water contents was increased in control group mice after CA/CPR (n=10) compared with those in sham operated mice (n=5) (79.5±0.85% vs 78.3±0.14%, P=0.003). Compared with control group, landiolol treatment significantly reduced brain water content in mice subjected to CA/CPR (n=12) (78.9±0.51% vs 79.5±0.85%, P=0.04). Conclusion: Landiolol attenuated brain edema following CA/CPR. These results may suggest selective β1-blocker could be alternative treatment for neuroprotection in patients who suffered CA/CPR.

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Masquerading Clinical Features Associated With Sudden Cardiac Arrest in Sarcoidosis

JACC: Clinical Electrophysiology ◽

10.1016/j.jacep.2021.02.012 ◽

2021 ◽

Vol 7 (9) ◽

pp. 1096-1098

Author(s):

Jonathan Chrispin

Keyword(s):

Cardiac Arrest ◽

Clinical Features ◽

Sudden Cardiac Arrest

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Post-resuscitative clinical features in the first hour after achieving sustained ROSC predict the duration of survival in children with non-traumatic out-of-hospital cardiac arrest

Resuscitation ◽

10.1016/j.resuscitation.2010.01.006 ◽

2010 ◽

Vol 81 (4) ◽

pp. 410-417 ◽

Cited By ~ 24

Author(s):

Yan-Ren Lin ◽

Chao-Jui Li ◽

Tung-Kung Wu ◽

Yu-Jun Chang ◽

Shih-Chang Lai ◽

...

Keyword(s):

Cardiac Arrest ◽

Clinical Features ◽

Hospital Cardiac Arrest

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Cerebral Edema After Cardiopulmonary Resuscitation: A Therapeutic Target Following Cardiac Arrest?

Neurocritical Care ◽

10.1007/s12028-017-0474-8 ◽

2017 ◽

Vol 28 (3) ◽

pp. 276-287 ◽

Cited By ~ 15

Author(s):

Erik G. Hayman ◽

Akil P. Patel ◽

W. Taylor Kimberly ◽

Kevin N. Sheth ◽

J. Marc Simard

Keyword(s):

Cardiac Arrest ◽

Cardiopulmonary Resuscitation ◽

Cerebral Edema ◽

Therapeutic Target

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Background Frequency Patterns in Standard Electroencephalography During Targeted Temperature Management as an Early Prognostic Tool in Out-of-Hospital Cardiac Arrest Survivors: a retrospective cohort study

10.21203/rs.2.20295/v1 ◽

2020 ◽

Author(s):

Youn-Jung Kim ◽

Min-jee Kim ◽

Yong Seo Koo ◽

Won Young Kim

Keyword(s):

Cardiac Arrest ◽

Clinical Features ◽

Targeted Temperature Management ◽

Neurologic Outcome ◽

Temperature Management ◽

Background Frequency ◽

Prognostic Tool ◽

Logistic Analysis ◽

Good Neurologic Outcome ◽

Hospital Cardiac Arrest

Abstract Background Electroencephalography is a widely used tool for detecting epileptiform and assessing neurological outcomes after cardiac arrest. We investigated the prognostic value of standard electroencephalography during early post-cardiac arrest period and evaluated the performance of electroencephalography findings combined with other clinical features for predicting good outcome. Methods This observational registry-based study was conducted at tertiary care hospital in Korea. Data of all consecutive adult comatose out-of-hospital cardiac arrest survivors who underwent electroencephalography during targeted temperature management between 2010 and 2018 were extracted. Electroencephalography findings, classiﬁed according to the American Clinical Neurophysiological Society critical care electroencephalography terminology, and good neurologic outcome-related clinical features were identified via multivariable logistic analysis. Results Good outcomes were observed in 36.5% of 170 patients. Median electroencephalography time was 22.0 hours. Electroencephalography background, voltage and other findings (burst suppression, reactivity to pain stimuli) significantly differed between good and poor outcome groups. Electroencephalography background with dominant alpha and theta waves had the highest odds ratio of 9.8 (95% confidence interval 3.9-24.9) in multivariable logistic analysis. Electroencephalography background frequency enabled identification of a good neurologic outcome (sensitivity, 83.87%; specificity, 75.93%). Combination of other clinical features (age<65 years, initial shockable rhythm, resuscitation duration<20 min) with electroencephalography findings increased predictive performance for good neurologic outcomes (sensitivity, 95.2%; specificity, 100%). ConclusionsBackground frequency patterns of standard electroencephalography during targeted temperature management may play a role as an early prognostic tool in out-of-hospital cardiac arrest patients.

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Abstract 270: Non-Invasive Cerebral Perfusion and Autoregulation Monitoring Post-Cardiac Arrest

Circulation ◽

10.1161/circ.138.suppl_2.270 ◽

2018 ◽

Vol 138 (Suppl_2) ◽

Author(s):

Reem Kashlan ◽

Kaleem Chaudhry ◽

Eric Ohlson ◽

Joseph B Miller

Keyword(s):

Cardiac Arrest ◽

Pilot Study ◽

Cerebral Edema ◽

Cerebral Perfusion ◽

Statistical Significance ◽

Pulseless Electrical Activity ◽

Spontaneous Circulation ◽

Perfusion Measurement ◽

Non Invasive ◽

Perfusion Measurements

Objective: The primary aim of this study was to test the feasibility of non-invasive cerebral perfusion monitoring post-arrest. We secondarily tested the association between measured autoregulation, the presence of cerebral edema, and neurological recovery. Methods: This was a prospective, pilot study inclusive of patients successfully resuscitated from cardiac arrest in the Emergency Department (ED). After return of spontaneous circulation, an investigator placed non-invasive, bifrontal monitoring to measure cerebral perfusion. The device uses an acousto-optic sensor to measure continuous cerebral perfusion and measurements are arbitrary units between 0-100, where 0 represents no flow (Ornim, Tel Aviv). Subjects had invasive, continuous arterial monitoring to assess mean arterial pressure (MAP). Multimodal measurements continued for 60 minutes. We calculated a Pearson coefficient between the perfusion measurements and MAP as an assessment of cerebral autoregulation, where a correlation coefficient > 0.3 indicates poor autoregulation, and a coefficient of 1 indicates completely passive cerebral perfusion to changes in MAP. Head computed tomography defined the presence of cerebral edema in the ED. Results: We enrolled 14 patients post-arrest with sustained return of circulation. The mean age was 55 ± 14 years, 7 were female, and 10 were African American. Six patients had pulseless electrical activity, 5 asystole, and 2 ventricular fibrillation. Bystander CPR rates were low (4 of 14, 31%). Two patients (14%) survived to hospital discharge. Cerebral perfusion was comparable between patients that survived and those that died (difference 3.1, 95% CI -14 to 8). Cerebral perfusion measurement was higher in patients with cerebral edema (difference 6.1, 95% CI 0.2 - 11.9). Autoregulation was worse in the presence of edema (0.30) compared to no edema (0.14), though this difference did not reach statistical significance (95% CI -0.7 to 0.4). Conclusions: In a pilot study, non-invasive post-arrest perfusion measurements plus coupling with MAP for autoregulation was feasible. Perfusion measurements were increased in the presence of cerebral edema but whether such measurements have prognostic value requires further study.

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Less frequent causes of SCD (commotio cordis): non-cardiac causes (drug abuse, hyperpyrexia, rhabdomyolysis, sickle cell anaemia)—Part 1

The ESC Textbook of Sports Cardiology ◽

10.1093/med/9780198779742.003.0036 ◽

2019 ◽

pp. 328-332

Author(s):

Erik Ekker Solberg ◽

Paolo Emilio Adami

Keyword(s):

Cardiac Arrest ◽

Drug Abuse ◽

Clinical Features ◽

Sickle Cell ◽

Environmental Conditions ◽

Health Personnel ◽

Sickle Cell Trait ◽

Aortic Rupture ◽

Sudden Cardiac Arrest ◽

Commotio Cordis

It is important to be aware of the clinical features of less frequent causes of SCD in Europe (e.g. commotio cordis and aortic rupture) and non-cardiac causes (e.g. drug abuse, hyperpyrexia, rhabdomyolysis, sickle cell trait, asthma, and extreme environmental conditions). Lay people and health personnel may not understand the mechanisms leading to sudden cardiac arrest and therefore not act properly. This chapter describes these conditions and their relation to sudden cardiac arrest, and provides advice for prevention and action in actual cases.

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