Abstract 62: Preserved Cerebral Microcirculation After Cardiac Arrest in an Asphyxial Rat Model

Introduction: Cardiac arrest (CA) carries a dismal prognosis, mainly due to neurological injury. Studies have reported dysfunction of the sublingual microcirculation following cardiac arrest. The objective of the study was to investigate if this microcirculatory dysfunction is also present in the brain after cardiac arrest. Methods: Anesthetized, intubated, and ventilated, male Sprague-Dawley rats were randomized into two CA groups and two control groups and observed for 120 min or 360 min following return of spontaneous circulation (CA120min (n=8), Control120min (n=8), CA360min (n=8), and Control360min (n=8)). After ten minutes of ashpyxial induced CA animals were resuscitated using adrenalin and manual CPR. At the end of the observation period, cerebral microcirculation was evaluated by side stream dark field microscopy through a parietal craniotomy, and plasma samples were drawn for endothelial adhesion molecule and inflammatory marker analyses. Animals were monitored with invasive blood pressure, ECG and arterial blood gas samples throughout the study. Results: At the end of the observation period mean arterial pressure decreased significantly in the cardiac arrest groups being 55±12mmHg in the CA120min group and 51±9mmHg in the CA360min group compared to 85±8mmHg in the control groups, whereas PaCO2 was kept in the normal range and did not differ between groups. There was no difference between groups for total vessel density, perfused vessel density, proportion of perfused vessels, or microvascular flow index measured in the cerebral cortex. Plasma samples drawn 360 min after return of spontaneous circulation showed a significant increase in E-selectin, L-selectin, I-CAM1, IL-1β, IL-6, IL-10 and elastase compared to controls. Between the CA groups E-selectin and elastase showed an increase from 120 to 360 min after resuscitation (p<0.007). Conclusion: Despite a significantly lower mean arterial pressure and elevated levels of soluble endothelial adhesion molecules and inflammatory cytokines, side stream dark field revealed no changes in the cerebral microcirculation in the early post resuscitation period.

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Loperamide Induced Recurrent Torsades de Pointes: A Case Report

Journal of Pharmacy Practice ◽

10.1177/08971900211004832 ◽

2021 ◽

pp. 089719002110048

Author(s):

Gregory G. Jackson ◽

Christine R. Lopez ◽

Elizabeth S. Bermudez ◽

Nina E. Hill ◽

Dan M. Roden ◽

...

Keyword(s):

Cardiac Arrest ◽

Torsades De Pointes ◽

Altered Mental Status ◽

Spontaneous Circulation ◽

Prior History ◽

Common Phenomenon ◽

Medical Providers ◽

Return Of Spontaneous Circulation ◽

History Of ◽

Overdrive Pacing

Purpose: A case of loperamide-induced recurrent torsades de pointes is reported to raise awareness of an increasingly common phenomenon that could be encountered by medical providers during the current opioid epidemic. Summary: A 40 year-old-man with a prior history of opioid abuse who presented to the emergency department after taking up to 100 tablets of loperamide 2 mg daily for 5 years to blunt opioid withdrawal symptoms and was subsequently admitted to the intensive care unit for altered mental status and hyperthermia. The patient had prolonged QTc and 2 episodes of torsades de pointes (TdP) that resulted in cardiac arrest with return of spontaneous circulation. He was managed with isoproterenol, overdrive pacing, and methylnatrexone with no other events of TdP or cardiac arrest. Conclusion: A 40-year-old male who developed torsades de pointes from loperamide overdose effectively treated with overdrive pacing, isoproterenol, and methylnatrexone.

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Non-invasive diffuse optical neuromonitoring during cardiopulmonary resuscitation predicts return of spontaneous circulation

Scientific Reports ◽

10.1038/s41598-021-83270-5 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Tiffany S. Ko ◽

Constantine D. Mavroudis ◽

Ryan W. Morgan ◽

Wesley B. Baker ◽

Alexandra M. Marquez ◽

...

Keyword(s):

Cardiac Arrest ◽

Cardiopulmonary Resuscitation ◽

Hemoglobin Concentration ◽

Spontaneous Circulation ◽

Youden Index ◽

Swine Model ◽

Return Of Spontaneous Circulation ◽

Non Invasive ◽

Tissue Optical Properties ◽

Tenfold Cross Validation

AbstractNeurologic injury is a leading cause of morbidity and mortality following pediatric cardiac arrest. In this study, we assess the feasibility of quantitative, non-invasive, frequency-domain diffuse optical spectroscopy (FD-DOS) neuromonitoring during cardiopulmonary resuscitation (CPR), and its predictive utility for return of spontaneous circulation (ROSC) in an established pediatric swine model of cardiac arrest. Cerebral tissue optical properties, oxy- and deoxy-hemoglobin concentration ([HbO2], [Hb]), oxygen saturation (StO2) and total hemoglobin concentration (THC) were measured by a FD-DOS probe placed on the forehead in 1-month-old swine (8–11 kg; n = 52) during seven minutes of asphyxiation followed by twenty minutes of CPR. ROSC prediction and time-dependent performance of prediction throughout early CPR (< 10 min), were assessed by the weighted Youden index (Jw, w = 0.1) with tenfold cross-validation. FD-DOS CPR data was successfully acquired in 48/52 animals; 37/48 achieved ROSC. Changes in scattering coefficient (785 nm), [HbO2], StO2 and THC from baseline were significantly different in ROSC versus No-ROSC subjects (p < 0.01) after 10 min of CPR. Change in [HbO2] of + 1.3 µmol/L from 1-min of CPR achieved the highest weighted Youden index (0.96) for ROSC prediction. We demonstrate feasibility of quantitative, non-invasive FD-DOS neuromonitoring, and stable, specific, early ROSC prediction from the third minute of CPR.

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