Bedside microdialysis for detection of early brain injury after out-of-hospital cardiac arrest

AbstractBedside detection and early treatment of lasting cerebral ischemia may improve outcome after out-of-hospital cardiac arrest (OHCA). This feasibility study explores the possibilities to use microdialysis (MD) for continuous monitoring of cerebral energy metabolism by analyzing the draining cerebral venous blood. Eighteen comatose patients were continuously monitored with jugular bulb and radial artery (reference) MD following resuscitation. Median time from cardiac arrest to MD was 300 min (IQR 230–390) with median monitoring time 60 h (IQR 40–81). The lactate/pyruvate ratio in cerebral venous blood was increased during the first 20 h after OHCA, and significant differences in time-averaged mean MD metabolites between jugular venous and artery measurements, were documented (p < 0.02). In patients with unfavorable outcome (72%), cerebral venous lactate and pyruvate levels remained elevated during the study period. In conclusion, the study indicates that jugular bulb microdialysis (JBM) is feasible and safe. Biochemical signs of lasting ischemia and mitochondrial dysfunction are frequent and associated with unfavorable outcome. The technique may be used in comatose OHCA patients to monitor biochemical variables reflecting ongoing brain damage and support individualized treatment early after resuscitation.

Download Full-text

Abstract 11617: Personalizing Outcomes After Child Cardiac Arrest (POCCA): A Preliminary Biomarker Report

Circulation ◽

10.1161/circ.144.suppl_2.11617 ◽

2021 ◽

Vol 144 (Suppl_2) ◽

Author(s):

Ericka L Fink ◽

Patrick M Kochanek ◽

Ashok Panigrahy ◽

Sue R Beers ◽

Rachel P Berger ◽

...

Keyword(s):

Cardiac Arrest ◽

Brain Injury ◽

Cerebral Performance Category ◽

Pediatric Intensive Care ◽

Early Brain Injury ◽

Unfavorable Outcome ◽

Neurofilament Light ◽

Multicenter Observational Study ◽

Child Centered ◽

One Year

Blood-based brain injury biomarkers show promise to prognosticate outcome for children resuscitated from cardiac arrest. The objective of this multicenter, observational study was to validate promising biomarkers to accurately prognosticate outcome at 1 year. Early brain injury biomarkers will be associated with outcome at one year for children with cardiac arrest. Fourteen centers in the US enrolled children aged < 18 years with in- or out-of-hospital cardiac arrest and pediatric intensive care unit admission if pre-cardiac arrest Pediatric Cerebral Performance Category score was 1-3. Glial fibrillary acidic protein (GFAP), ubiquitin carboxyl-terminal esterase L1 (UCHL1), neurofilament light (NfL), and Tau protein concentrations were measured in samples drawn post-arrest day 1 using Quanterix Simoa 4-Plex assay. The primary outcome was unfavorable outcome at one year (Vineland Adaptive Behavioral Scale < 70). Of 164 children enrolled, 120 children had evaluable data (n=50 with unfavorable outcome). Children were median (interquartile range) 1 (0-8.5) years of age, 41% female, and 60% had asphyxia etiology. Of children with unfavorable outcome, 93% had unwitnessed arrests and 43 died. While all 4 day 1 biomarkers were increased in children with unfavorable vs. favorable outcome at 1-year post-arrest, NfL had the best univariate area under the receiver operator curve to predict 1 year outcome at 0.731. In a multivariate logistic regression, NfL concentration trended toward significance on day 1 and was associated with unfavorable outcome at 1-year on days 2 and 3 (day 1: Odds Ratio [95% Confidence Interval] 1.004 [1.000-1.008], p=.062; day 2: 1.005 [1.002-1.008], p=.003, and day 3: 1.002 [1.001-1.004], p=.003, respectively). UCHL1 was associated with outcome on days 2: 1.005 [1.002-1.009], p=.003 and 3: 1.001 [1.000-1.002], p=.019) and Tau trended toward association with outcome on days 2: 1.003 [1.000-1.005], p=.08) and 3: 1.001 [1.000-1.002], p=.077. Brain injury biomarkers predict unfavorable outcome post-pediatric cardiac arrest. Accuracy of biomarkers alone and together with other prognostication tools should be evaluated to predict long term child centered outcomes post-cardiac arrest.

Download Full-text

Abstract 55: The CAHP (Cardiac Arrest Hospital Prognosis) Score: Predicting Neurological Outcome After Out-of-Hospital Cardiac Arrest

Circulation ◽

10.1161/circ.130.suppl_2.55 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

Carole Maupain ◽

Wulfran Bougouin ◽

Lamhaut Lionel ◽

Nicolas Deye ◽

Daniel Jost ◽

...

Keyword(s):

Cardiac Arrest ◽

High Risk ◽

Neurological Outcome ◽

Risk Group ◽

Unfavorable Outcome ◽

Validation Dataset ◽

Group Score ◽

Poor Neurological Outcome ◽

Hospital Cardiac Arrest ◽

Prognosis Score

Background: Out-of-hospital cardiac arrest (OHCA) carries a very poor prognosis. Early prognostication of patients admitted in ICU after resuscitated OHCA is a key issue but remains challenging. The aim of that study was to establish a new scoring system to predict poor neurological outcome in these patients. Materials and Methods: The CAHP (Cardiac Arrest Hospital Prognosis) score was developed from the Sudden Death Expertise Center registry (SDEC, Paris, France). Objective risk factors were weighted on the basis of a logistic regression analysis. The primary outcome was poor neurological outcome defined as Cerebral Performance Category 3, 4 or 5. Thresholds were defined to distinguish low, moderate and high-risk groups. The CAHP score was then validated in an external dataset (Parisian OHCA Registry). Score calibration and discrimination characteristics were assessed in the validation dataset. Results: The developmental dataset included 819 patients admitted in ICU from May 2011 to December 2012. After logistic regression, 7 variables were independently associated with poor neurological outcome: age, initial shockable rhythm, time form collapse to basic life support (BLS), time from BLS to return of spontaneous circulation (ROSC), location of cardiac arrest, epinephrine dose during resuscitation and arterial pH at admission. These variables were included in the CAHP score. 3 risks groups were identified: a low risk group (score ≤ 150, 39 % of unfavorable outcome), medium risk group (score 150-200, 81% of unfavorable outcome) and high-risk group (CAHP score ≥ 200, 100 % of unfavorable outcome). AUC of the CAHP score was 0.93. In the external validation dataset, discrimination value of the CAHP score was consistent with an AUC of 0.85. Conclusion: The CAHP score is a simple and objective tool for early assessment of prognosis in patients admitted to ICU after OHCA. Moreover it allows to stratify the probability of poor neurological outcome by identifying a very high-risk category of patients (score ≥ 200).

Download Full-text

Venous blood lactate on admission is a predictor for in-hospital cardiac arrest—An observational cohort study

Resuscitation ◽

10.1016/j.resuscitation.2012.08.069 ◽

2012 ◽

Vol 83 ◽

pp. e27-e28

Author(s):

Charlotte Barfod ◽

Lars Hyldborg Lundstrøm ◽

Marlene Mauson Pankoke Lauritzen ◽

Jakob Klim Danker ◽

György Sölétormos ◽

...

Keyword(s):

Cardiac Arrest ◽

Cohort Study ◽

Blood Lactate ◽

Venous Blood ◽

Observational Cohort Study ◽

Observational Cohort ◽

Venous Blood Lactate ◽

Hospital Cardiac Arrest

Download Full-text

Early jugular bulb oxygenation monitoring in comatose patients after an out-of-hospital cardiac arrest

Intensive Care Medicine ◽

10.1007/bf01700161 ◽

1995 ◽

Vol 21 (7) ◽

pp. 567-572 ◽

Cited By ~ 16

Author(s):

J. G. van der Hoeven ◽

J. de Koning ◽

E. A. Compier ◽

A. E. Meinders

Keyword(s):

Cardiac Arrest ◽

Jugular Bulb ◽

Oxygenation Monitoring ◽

Hospital Cardiac Arrest

Download Full-text

Prognostic Value of Venous Blood Ammonia in Patients With Out-of-Hospital Cardiac Arrest

Circulation Journal ◽

10.1253/circj.cj-11-0449 ◽

2012 ◽

Vol 76 (4) ◽

pp. 891-899 ◽

Cited By ~ 10

Author(s):

Asuka Kasai ◽

Ken Nagao ◽

Kimio Kikushima ◽

Kazuhiro Watanabe ◽

Eizo Tachibana ◽

...

Keyword(s):

Cardiac Arrest ◽

Prognostic Value ◽

Venous Blood ◽

Blood Ammonia ◽

Hospital Cardiac Arrest

Download Full-text

Continuous monitoring of out-of-hospital cardiac arrest in municipality Sombor - EuReCa_Srbija

Journal Resuscitatio Balcanica ◽

10.5937/jrb1810118h ◽

2018 ◽

Vol 40 (10) ◽

pp. 113-117

Author(s):

Snežana Holcer-Vukelić ◽

Ivan Pešić

Keyword(s):

Cardiac Arrest ◽

Continuous Monitoring ◽

Hospital Cardiac Arrest

Download Full-text

Association of MRI brain injury with outcome after pediatric out-of-hospital cardiac arrest

Neurology ◽

10.1212/wnl.0000000000011217 ◽

2020 ◽

pp. 10.1212/WNL.0000000000011217

Author(s):

Matthew P. Kirschen ◽

Daniel J. Licht ◽

Jennifer Faerber ◽

Antara Mondal ◽

Kathryn Graham ◽

...

Keyword(s):

Cardiac Arrest ◽

Hospital Discharge ◽

Primary Outcome ◽

Brain Mri ◽

Unfavorable Outcome ◽

Diffusion Restriction ◽

Mri Brain ◽

Mri Scans ◽

Pediatric Mri ◽

Hospital Cardiac Arrest

ObjectiveDetermine the association between the extent of diffusion restriction and T2/FLAIR injury on brain MRI and outcomes after pediatric out-of-hospital cardiac arrest (OHCA).MethodsDiffusion restriction and T2/FLAIR injury were described according to the pediatric MRI modification of the Alberta Stroke Program Early Computed Tomography Score for children from 2005 to 2013 who had an MRI within 14 days of OHCA. The primary outcome was unfavorable neurologic outcome defined as ≥1 change in PCPC from baseline resulting in a hospital discharge PCPC score 3, 4, 5, or 6. Patients with unfavorable outcomes were further categorized into alive with PCPC 3–5, dead due to withdrawal of life sustaining therapies for poor neurologic prognosis (WLST-neuro), or dead by neurologic criteria.ResultsWe evaluated MRI scans from 77 patients (median age 2.21 [IQR 0.44, 13.07] years) performed 4 [2, 6] days post-arrest. Patients with unfavorable outcomes had more extensive diffusion restriction (median 7 [4, 10.3] vs 0 [0, 0] regions, p < 0.001) and T2/FLAIR injury (5.5 [2.3, 8.2] vs 0 [0, 0.75] regions, p < 0.001) compared to patients with favorable outcomes. AUROC for the extent of diffusion restriction and unfavorable outcome was 0.96 (95% CI, 0.91, 0.99) and 0.92 (95% CI, 0.85, 0.97) for T2/FLAIR injury. There was no difference in extent of diffusion restriction between patients who were alive with an unfavorable outcome and patients who died from WLST-neuro (p = 0.11).ConclusionsMore extensive diffusion restriction and T2/FLAIR injury on the modsASPECTS score within the first 14 days after pediatric cardiac arrest was associated with unfavorable outcomes at hospital discharge.

Download Full-text