A302 MULTIFOCAL CEREBRAL BLOOD FLOW (CBF) AND GLOBAL METABOLISM (CMR) AFTER PROLONGED CARDIAC ARREST IN DOGS. EFFECT OF MILD HYPOTHERMIA (34°C)

Assessing brain death may sometimes be difficult, with isoelectric EEG following psychotrope overdoses or normal cerebral blood flow (CBF) persisting despite brain death in the case of ventricular drainage or craniotomy. A 42-year-old man, resuscitated after cardiac arrest following a suicidal ingestion of ethanol, bromazepam and zopiclone, was admitted in deep coma. On day 4, his brainstem reflexes and EEG activity disappeared. On day 5, his serum bromazepam concentration was 817 ng/ml (therapeutic: 80-150). The patient was unresponsive to 1 mg of flumazenil. MRI showed diffuse cerebral swelling. CBF assessed by angiography and Doppler remained normal and EEG isoelectric until he died on day 8 with multiorgan failure. There was a discrepancy between the clinically and EEG-assessed brain death, and CBF persistence. We hypothesized that brain death, resulting from diffuse anoxic injury, may lead, in the absence of major intracranial hypertension, to angiographic misdiagnoses. Therefore, EEG remains useful to assess diagnosis in such unusual cases.

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Continuous Chest Compressions with Asynchronous Ventilations Increase Cerebral Blood Flow and Oxygen Delivery in the Perinatal Asphyxiated Cardiac Arrest Lamb Model

10.1542/peds.147.3_meetingabstract.688 ◽

2021 ◽

Author(s):

MD payam vali ◽

Peggy Chen ◽

Ziad Alhassen ◽

Amy Lesneski ◽

Morgan Hardie ◽

...

Keyword(s):

Blood Flow ◽

Cardiac Arrest ◽

Cerebral Blood Flow ◽

Oxygen Delivery ◽

Chest Compressions

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Influence of Nimodipine on Cerebral Blood Flow After Cardiac Arrest in Humans

Nimodipine ◽

10.1007/978-3-642-48695-1_19 ◽

1991 ◽

pp. 197-204

Author(s):

M. Forsman

Keyword(s):

Blood Flow ◽

Cardiac Arrest ◽

Cerebral Blood Flow

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Cerebral Circulation and Cerebral Blood Flow

Mayo Clinic Critical and Neurocritical Care Board Review ◽

10.1093/med/9780190862923.003.0010 ◽

2019 ◽

pp. 79-85

Author(s):

Arnoley S. Abcejo ◽

Jeffrey J. Pasternak

Keyword(s):

Blood Flow ◽

Cardiac Arrest ◽

Cerebral Blood Flow ◽

Brain Injury ◽

Ischemic Brain Injury ◽

Ischemic Brain ◽

Neurologic Outcomes ◽

The Us ◽

Hospital Cardiac Arrest ◽

Premonitory Symptoms

Cardiac arrest occurs suddenly, often without premonitory symptoms. Consciousness is lost within seconds to minutes because of insufficient cerebral blood flow in the midst of complete hemodynamic collapse. Anoxic-ischemic brain injury is most commonly caused by cardiac arrest, which is frequently lethal; of the US patients with out-of-hospital cardiac arrest treated by emergency medical services, almost 90% die. Among the patients who survive to hospital admission, inpatient mortality may be decreasing, but a substantial number of those survivors have poor neurologic outcomes from anoxic-ischemic brain injury.

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Changes in cerebral blood flow and oxygen metabolism during moderate hypothermia in patients with severe middle cerebral artery infarction

Neurosurgical FOCUS ◽

10.3171/foc.2000.8.5.4 ◽

2000 ◽

Vol 8 (5) ◽

pp. 1-4 ◽

Cited By ~ 11

Author(s):

Emanuela Keller ◽

Thorsten Steiner ◽

Javier Fandino ◽

Stefan Schwab ◽

Werner Hacke

Keyword(s):

Blood Flow ◽

Cerebral Blood Flow ◽

Ischemic Stroke ◽

Middle Cerebral Artery ◽

Cerebral Artery ◽

Mild Hypothermia ◽

Indicator Dilution ◽

Dilution Method ◽

Moderate Hypothermia ◽

Double Indicator Dilution

Object Moderate hypothermia has been reported to be effective in the treatment of postischemic brain edema. The effect of hypothermia on cerebral hemodynamics is a matter of controversial discussion in literature. Clinical studies have yet to be performed in patients with ischemic stroke after induction of hypothermia. Methods Measurements during mild hypothermia (33–34°C) were made in six patients with severe ischemic stroke involving the middle cerebral artery territory. Hypothermia was induced as soon as possible and maintained for 48 to 72 hours. Cerebral blood flow (CBF) and cerebral metabolic rate of oxygen (CMRO2) were estimated by a new double-indicator dilution method. Measurements of CBF were made during normothermia, immediately after induction of hypothermia, at the end of hypothermia, and after rewarming. A total of 19 measurements of CBF and jugular bulb O2 saturation were made. Immediately after induction of hypothermia, CBF decreased in all patients. During late hypothermia, CBF improved in patients who survived but remained diminished in the two patients who died. Reduced CMRO2 levels were observed during all phases of hypothermia in all but one case. Conclusions Preliminary oberservations indicate that moderate hypothermia seems to reduce CMRO2 Immediately after induction of hypothermia, CBF may decrease in all patients. During late hypothermia CBF seems to recover in patients with good outcome but remains diminished in patients who die. Serial bedside CBF measurements with the new double-indicator dilution technique may be useful to describe cerebral hemodynamic characteristics in patients with severe ischemic stroke during hypothermia.

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