Abstract 09: Ultra-Fast Hypothermia Inhibit Early Cerebral Consumption of Lactate After Experimental Cardiac Arrest in Rabbits : A Microdialysis Study

Circulation ◽  
2018 ◽  
Vol 138 (Suppl_2) ◽  
Author(s):  
Matthias Kohlhauer ◽  
Alexandra Demelos ◽  
Emilie Boissady ◽  
Bijan Ghaleh ◽  
Renaud Tissier
Keyword(s):  
Blood Flow ◽  
Cardiac Arrest ◽  
Spontaneous Circulation ◽  
Therapeutic Window ◽  
Ultra Fast Cooling ◽  
Extracellular Lactate ◽  
Microdialysis Study ◽  
The Right ◽  
And Control

Introduction: Ultra-fast hypothermia through total liquid ventilation (TLV) has been shown to be neuroprotective after cardiac arrest. Hypothesis: The mechanism could involve a modification in brain metabolic substrat. Method: Anesthetized rabbits were instrumented with a carotid flow probe as well as arterial and jugular venous catheters. A microdialysis catether was implanted in the right brain cortex. Animals were then submitted to 10 min of ventricular fibrillation and cardiopulmonary resuscitation. After resumption of spontaneous circulation (ROSC), they were randomly submitted to ultra-fast cooling to 32°C by TLV (TLV group) or normothermic follow-up (Control) during 4h. Cerebral consumption of lactate, glucose and O 2 was calculated using arteriovenous differences in their content times mean carotid blood flow. Results: In Control, cerebral blood flow was significantly and sustainly decreased after ROSC (61±6 vs 101±6 ml/min after 240 min vs baseline), with a further decrease with hypothermia in TLV group (23±2 ml/min after 240 min, p<0.05). As compared to Control, TLV reduced the cerebral consumption of glucose (-69% at 240 min) and O 2 (-73% at 240 min). Importantly, Control animals showed a dramatic but transient cerebral consumption of lactate during the first 120 min after cardiac arrest (e.g. 124±31 mmol/min at 60 min). Concomitantly, this was associated with an increase in pyruvate extracellular stocks in brain (e.g. 57±10 μmol/L at 30 min). In TLV group, hypothermia blunted this initial burst of lactate consumption (e.g. 41±12 mmol/min at 60 min, p<0,05) and led to an accumulation in extracellular lactate ( e.g. 2053±68 vs 1246±278 μmol/L at 60 min, in TLV and Control respectively). This early build-up of lactate was then progressively consumed after 120 min in TLV group, allowing a delayed accumulation in pyruvate extracellular stocks from 120 min until the end of follow-up (103±19 and 17±4 μmol/L of pyruvate at 240 min in TLV vs Control respectively). Conclusion: Ultra-fast hypothermia reduces the cerebral consumption of lactate during the first 120 min after ROSC, allowing a delayed renewal in pyruvate stocks. This could explain the potent benefit of hypothermia during this early therapeutic window of 120 min.

Regional cerebral blood flow patterns of change following the own body image exposure in eating disorders: A longitudinal study

2009 ◽  
Vol 24 (5) ◽  
pp. 275-281 ◽  
Author(s):  
Teresa Rodriguez-Cano ◽  
Luis Beato-Fernandez ◽  
Inmaculada Garcia-Vilches ◽  
Ana Garcia-Vicente ◽  
Victor Poblete-Garcia ◽  
...  
Keyword(s):  
Body Image ◽  
Blood Flow ◽  
Cerebral Blood Flow ◽  
Body Dissatisfaction ◽  
Regional Cerebral Blood Flow ◽  
Whole Body ◽  
Regional Cerebral Blood ◽  
Temporal Area ◽  
The Right

AbstractObjectiveThe aim of the present study is to see if the changes in the regional cerebral blood flow (rCBF) experienced by restrictive anorexia nervosa (AR) and bulimia nervosa (BN) patients, following the exposure to their own body image, persist at follow-up.MethodsThree single photon emission computed tomography (SPECT) were performed on nine patients with a DSM-IV diagnosis of AR, 13 with BP, and 12 controls: at rest, following a neutral stimulus, and after exposure to their previously filmed whole body image. Body dissatisfaction was measured by means of the Body Dissatisfaction Questionnaire (BSQ). One year later the same assessment was repeated.ResultsFollowing the exposure to their own body image, BN showed an increase in body dissatisfaction, which was associated with the increase in the rCBF of the Right Temporal Area. Those changes persisted at follow-up.DiscussionMore specific long term therapies are needed for the treatment of the averse response showed by ED patients to their own body image exposure that is associated with the hyperactivation of the right temporal area when they are confronted with their whole body image.

Abstract 114: Effect of Body Position on Intracranial Pressure and Carotid Blood Flow During Extracorporeal Cardiopulmonary Resuscitation

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_4) ◽  
Author(s):  
Yaël Levy ◽  
Rocio Fernandez ◽  
Fanny Lidouren ◽  
Matthias Kohlhauer ◽  
Lionel Lamhaut ◽  
...  
Keyword(s):  
Blood Flow ◽  
Cardiac Arrest ◽  
Intracranial Pressure ◽  
Cardiopulmonary Resuscitation ◽  
Body Position ◽  
Spontaneous Circulation ◽  
Systemic Hemodynamics ◽  
Body Tilt ◽  
Whole Body ◽  
Extracorporeal Cardiopulmonary Resuscitation

Introduction: Extracorporeal cardiopulmonary resuscitation (E-CPR) using extracorporeal membrane oxygenation (ECMO) is widely proposed for the treatment of refractory cardiac arrest. Hypothesis: Since cerebral autoregulation is altered in such conditions, body position may modify hemodynamics during ECPR. Our goal was to determine whether a whole body tilt-up challenge (TUC) could lower intracranial pressure (ICP) as previously shown with conventional CPR, without deteriorating cerebral blood flow (CBF). Methods: Pigs were anesthetized and instrumented for the continuous evaluation of CBF, ICP and systemic hemodynamics. After 15 min of untreated ventricular fibrillation they were treated with 30 min of E-CPR followed by sequential defibrillation shocks until resumption of spontaneous circulation (ROSC). ECMO was continued after ROSC to target a mean arterial pressure (MAP) >60 mmHg. Animals were maintained in the flat position (FP) throughout protocol, except during a 2 min TUC of the whole body (+30°) at baseline, during E-CPR and after-ROSC. Results: Four animals received the entire procedure and ROSC was obtained in 3/4. After cardiac arrest, E-CPR was delivered at 29±2 ml/kg/min to maintain a MAP of 57±8 mmHg in the FP. CBF was 28% of baseline and ICP remain stable (12±1 vs 13±1 mmHg during ECPR vs baseline, respectively). Under baseline pre-arrest conditions TUC resulted in a significant decrease in ICP (-63±7%) and CBF (-21±3%) versus the FP, with no significant effect on systemic hemodynamics. During E-CPR and after ROSC, TUC markedly reduced ICP but CBF remained unchanged vs the FP (Figure). Conclusion: During E-CPR whole body TUC reduced ICP without lowering CBF compared with E-CPR flat. Additional investigations with prolonged TUC and selective head and thorax elevation during E-CPR are warranted.

scholarly journals Double Bolus Thrombolysis for Suspected Massive Pulmonary Embolism during Cardiac Arrest

2015 ◽  
Vol 2015 ◽  
pp. 1-5 ◽  
Author(s):  
Gerard O’Connor ◽  
Gareth Fitzpatrick ◽  
Ayman El-Gammal ◽  
Peadar Gilligan
Keyword(s):  
Pulmonary Embolism ◽  
Cardiac Arrest ◽  
Recombinant Tissue Plasminogen Activator ◽  
Massive Pulmonary Embolism ◽  
Spontaneous Circulation ◽  
Right Heart ◽  
Tissue Plasminogen ◽  
End Tidal ◽  
The Right ◽  
High Level

More than 70% of cardiac arrest cases are caused by acute myocardial infarction (AMI) or pulmonary embolism (PE). Although thrombolytic therapy is a recognised therapy for both AMI and PE, its indiscriminate use is not routinely recommended during cardiopulmonary resuscitation (CPR). We present a case describing the successful use of double dose thrombolysis during cardiac arrest caused by pulmonary embolism. Notwithstanding the relative lack of high-level evidence, this case suggests a scenario in which recombinant tissue Plasminogen Activator (rtPA) may be beneficial in cardiac arrest. In addition to the strong clinical suspicion of pulmonary embolism as the causative agent of the patient’s cardiac arrest, the extremely low end-tidal CO2suggested a massive PE. The absence of dilatation of the right heart on subxiphoid ultrasound argued against the diagnosis of PE, but not conclusively so. In the context of the circulatory collapse induced by cardiac arrest, this aspect was relegated in terms of importance. The second dose of rtPA utilised in this case resulted in return of spontaneous circulation (ROSC) and did not result in haemorrhage or an adverse effect.

scholarly journals Effects of rewarming with extracorporeal membrane oxygenation to restore oxygen transport and organ blood flow after hypothermic cardiac arrest in a porcine model

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Jan Harald Nilsen ◽  
Torstein Schanche ◽  
Sergei Valkov ◽  
Rizwan Mohyuddin ◽  
Brage Haaheim ◽  
...  
Keyword(s):  
Blood Flow ◽  
Cardiac Arrest ◽  
Extracorporeal Membrane Oxygenation ◽  
Spontaneous Circulation ◽  
Aerobic Metabolism ◽  
Organ Blood Flow ◽  
Membrane Oxygenation ◽  
Chain Of Survival ◽  
Low Levels ◽  
The Brain

AbstractWe recently documented that cardiopulmonary resuscitation (CPR) generates the same level of cardiac output (CO) and mean arterial pressure (MAP) during both normothermia (38 °C) and hypothermia (27 °C). Furthermore, continuous CPR at 27 °C provides O2 delivery (ḊO2) to support aerobic metabolism throughout a 3-h period. The aim of the present study was to investigate the effects of extracorporeal membrane oxygenation (ECMO) rewarming to restore ḊO2 and organ blood flow after prolonged hypothermic cardiac arrest. Eight male pigs were anesthetized and immersion cooled to 27 °C. After induction of hypothermic cardiac arrest, CPR was started and continued for a 3-h period. Thereafter, the animals were rewarmed with ECMO. Organ blood flow was measured using microspheres. After cooling with spontaneous circulation to 27 °C, MAP and CO were initially reduced to 66 and 44% of baseline, respectively. By 15 min after the onset of CPR, there was a further reduction in MAP and CO to 42 and 25% of baseline, respectively, which remained unchanged throughout the rest of 3-h CPR. During CPR, ḊO2 and O2 uptake (V̇O2) fell to critical low levels, but the simultaneous small increase in lactate and a modest reduction in pH, indicated the presence of maintained aerobic metabolism. Rewarming with ECMO restored MAP, CO, ḊO2, and blood flow to the heart and to parts of the brain, whereas flow to kidneys, stomach, liver and spleen remained significantly reduced. CPR for 3-h at 27 °C with sustained lower levels of CO and MAP maintained aerobic metabolism sufficient to support ḊO2. Rewarming with ECMO restores blood flow to the heart and brain, and creates a “shockable” cardiac rhythm. Thus, like continuous CPR, ECMO rewarming plays a crucial role in “the chain of survival” when resuscitating victims of hypothermic cardiac arrest.

scholarly journals Therapeutic hypothermia promotes cerebral blood flow recovery and brain homeostasis after resuscitation from cardiac arrest in a rat model

2018 ◽  
Vol 39 (10) ◽  
pp. 1961-1973 ◽  
Author(s):  
Qihong Wang ◽  
Peng Miao ◽  
Hiren R Modi ◽  
Sahithi Garikapati ◽  
Raymond C Koehler ◽  
...  
Keyword(s):  
Blood Flow ◽  
Cardiac Arrest ◽  
Cerebral Blood Flow ◽  
Therapeutic Hypothermia ◽  
Neurological Outcome ◽  
Spontaneous Circulation ◽  
Early Application ◽  
Information Quantity ◽  
Multiple Parameters ◽  
Baseline Levels

Laboratory and clinical studies have demonstrated that therapeutic hypothermia (TH), when applied as soon as possible after resuscitation from cardiac arrest (CA), results in better neurological outcome. This study tested the hypothesis that TH would promote cerebral blood flow (CBF) restoration and its maintenance after return of spontaneous circulation (ROSC) from CA. Twelve Wistar rats resuscitated from 7-min asphyxial CA were randomized into two groups: hypothermia group (7 H, n = 6), treated with mild TH (33–34℃) immediately after ROSC and normothermia group (7 N, n = 6,37.0 ± 0.5℃). Multiple parameters including mean arterial pressure, CBF, electroencephalogram (EEG) were recorded. The neurological outcomes were evaluated using electrophysiological (information quantity, IQ, of EEG) methods and a comprehensive behavior examination (neurological deficit score, NDS). TH consistently promoted better CBF restoration approaching the baseline levels in the 7 H group as compared with the 7 N group. CBF during the first 5–30 min post ROSC of the two groups was 7 H:90.5% ± 3.4% versus 7 N:76.7% ± 3.5% ( P < 0.01). Subjects in the 7 H group showed significantly better IQ scores after ROSC and better NDS scores at 4 and 24 h. Early application of TH facilitates restoration of CBF back to baseline levels after CA, which in turn results in the restoration of brain electrical activity and improved neurological outcome.

Infant and Pediatric Cardiopulmonary Resuscitation

2021 ◽  
pp. 183-190
Author(s):  
Sarah Nizamuddin
Keyword(s):  
Blood Pressure ◽  
Blood Flow ◽  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Spontaneous Circulation ◽  
Rate Of Return ◽  
High Quality ◽  
Return Of Spontaneous Circulation ◽  
Shockable Rhythm ◽  
Level Of Importance

High-quality cardiopulmonary resuscitation (CPR) in children with cardiac arrest is vitally important to increase the chance of survival. The rate of return of spontaneous circulation from in-hospital cardiac arrests has improved between 2001 and 2013, from 39% to 77%. In adults, cardiac arrest is most commonly due to primary cardiac causes. In contrast, the cause of pediatric cardiac arrest is often asphyxia resulting in hypoxia. Because of this difference, there is a greater level of importance given to ventilation during infant and pediatric CPR. After recognition of the loss of pulse or blood pressure, quick initiation of CPR is necessary to provide blood flow to vital organs. Ensuring high-quality cardiopulmonary resuscitation in pediatric patients requires knowledge of the appropriate equipment, medications, and procedures. Quick recognition of the loss of spontaneous circulation should trigger an immediate call for help and initiation of chest compressions. Ventilation should be supported, and defibrillation should be performed when the patient is in a shockable rhythm. Epinephrine and other medications may also be required.

Follow-up Findings in Regional Cerebral Blood Flow (r-CBF)-SPECT in a Case of idiopathic Childhood Hemidystonia

1999 ◽  
Vol 38 (02) ◽  
pp. 72-74 ◽  
Author(s):  
J. Marienhagen ◽  
Judith Aderbauer ◽  
Elke Bock ◽  
H. Segerer ◽  
Chr. Eilles ◽  
...  
Keyword(s):  
Blood Flow ◽  
Regional Cerebral Blood Flow ◽  
Inborn Errors Of Metabolism ◽  
Successful Therapy ◽  
Regional Cerebral Blood ◽  
Inborn Errors ◽  
Left Hand ◽  
Hmpao Spect ◽  
The Right

SummaryA 9½-year-old girl suffered from intermitting tremor and jitteriness of her left hand and oral muscles every 4 to 6 weeks with long lasting episodes. Clinically myoclonias and dystonic positioning of the left arm, hand and facial muscles were seen. No evidence of trauma, infection or inborn errors of metabolism was found. Successful therapy with carbamazepine was initiated while L-DOPA failed. An ictal 99m-Tc-HMPAO-SPECT showed severe asymmetry with focal hyperperfusion of the contralateral right thalamus and basal ganglia as well as of the bifrontal cortex, whereas no anatomical lesions were found by MRI. In contrast, an interictally performed 99m-Tc-HMPAO SPECT showed hypoperfusion of the right thalamus and normalisation of the frontal perfusion under medical treatment. These 99m-Tc-HMPAO-SPECT findings may provide new insights into the localisation and pathophysiological pathways of idiopathic childhood dystonia.

scholarly journals Cerebral Blood Flow Predicts Conversion of Mild Cognitive Impairment into Alzheimer’s Disease and Cognitive Decline: An Arterial Spin Labeling Follow-up Study

2021 ◽  
pp. 1-13
Author(s):  
Wenna Duan ◽  
Grace D. Zhou ◽  
Arvind Balachandrasekaran ◽  
Ashish B. Bhumkar ◽  
Paresh B. Boraste ◽  
...  
Keyword(s):  
Alzheimer’S Disease ◽  
Blood Flow ◽  
Cerebral Blood Flow ◽  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Cognitive Decline ◽  
Arterial Spin Labeling ◽  
Spin Labeling ◽  
The Right

Background: This is the first longitudinal study to assess regional cerebral blood flow (rCBF) changes during the progression from normal control (NC) through mild cognitive impairment (MCI) and Alzheimer’s disease (AD). Objective: We aim to determine if perfusion MRI biomarkers, derived from our prior cross-sectional study, can predict the onset and cognitive decline of AD. Methods: Perfusion MRIs using arterial spin labeling (ASL) were acquired in 15 stable-NC, 14 NC-to-MCI, 16 stable-MCI, and 18 MCI/AD-to-AD participants from the Cardiovascular Health Study (CHS) cognition study. Group comparisons, predictions of AD conversion and time to conversion, and Modified Mini-Mental State Examination (3MSE) from rCBF were performed. Results: Compared to the stable-NC group: 1) the stable-MCI group exhibited rCBF decreases in the right temporoparietal (p = 0.00010) and right inferior frontal and insula (p = 0.0094) regions; and 2) the MCI/AD-to-AD group exhibited rCBF decreases in the bilateral temporoparietal regions (p = 0.00062 and 0.0035). Compared to the NC-to-MCI group, the stable-MCI group exhibited a rCBF decrease in the right hippocampus region (p = 0.0053). The baseline rCBF values in the posterior cingulate cortex (PCC) (p = 0.0043), bilateral superior medial frontal regions (BSMF) (p = 0.012), and left inferior frontal (p = 0.010) regions predicted the 3MSE scores for all the participants at follow-up. The baseline rCBF in the PCC and BSMF regions predicted the conversion and time to conversion from MCI to AD (p <  0.05; not significant after multiple corrections). Conclusion: We demonstrated the feasibility of ASL in detecting rCBF changes in the typical AD-affected regions and the predictive value of baseline rCBF on AD conversion and cognitive decline.

scholarly journals Predictive values of early head computed tomography for survival outcome after cardiac arrest in childhood: a pilot study

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Kenichi Tetsuhara ◽  
Noriyuki Kaku ◽  
Yuka Watanabe ◽  
Masaya Kumamoto ◽  
Yuko Ichimiya ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Cardiac Arrest ◽  
Brain Damage ◽  
Cerebral Performance Category ◽  
Spontaneous Circulation ◽  
Predictive Values ◽  
Head Ct ◽  
Neurological Outcomes ◽  
Head Computed Tomography

AbstractPredicting outcomes of children after cardiac arrest (CA) remains challenging. To identify useful prognostic markers for pediatric CA, we retrospectively analyzed the early findings of head computed tomography (CT) of patients. Subjects were non-traumatic, out-of-hospital CA patients < 16 years of age who underwent the first head CT within 24 h in our institute from 2006 to 2018 (n = 70, median age: 4 months, range 0–163). Of the 24 patients with return of spontaneous circulation, 14 survived up to 30 days after CA. The degree of brain damage was quantitatively measured with modified methods of the Alberta Stroke Program Early CT Score (mASPECTS) and simplified gray-matter-attenuation-to-white-matter-attenuation ratio (sGWR). The 14 survivors showed higher mASPECTS values than the 56 non-survivors (p = 0.035). All 3 patients with mASPECTS scores ≥ 20 survived, while an sGWR ≥ 1.14 indicated a higher chance of survival than an sGWR < 1.14 (54.5% vs. 13.6%). Follow-up magnetic resonance imaging for survivors validated the correlation of the mASPECTS < 15 with severe brain damage. Thus, low mASPECTS scores were associated with unfavorable neurological outcomes on the Pediatric Cerebral Performance Category scale. A quantitative analysis of early head CT findings might provide clues for predicting survival of pediatric CA.

scholarly journals Rewarming With Closed Thoracic Lavage Following 3-h CPR at 27°C Failed to Reestablish a Perfusing Rhythm

2021 ◽  
Vol 12 ◽  
Author(s):  
Joar O. Nivfors ◽  
Rizwan Mohyuddin ◽  
Torstein Schanche ◽  
Jan Harald Nilsen ◽  
Sergei Valkov ◽  
...  
Keyword(s):  
Blood Flow ◽  
Cardiac Arrest ◽  
Cardiac Output ◽  
Life Support ◽  
Spontaneous Circulation ◽  
Aerobic Metabolism ◽  
Organ Blood Flow ◽  
Circulatory Collapse ◽  
Low Levels ◽  
Modest Reduction

Introduction: Previously, we showed that the cardiopulmonary resuscitation (CPR) for hypothermic cardiac arrest (HCA) maintained cardiac output (CO) and mean arterial pressure (MAP) to the same reduced level during normothermia (38°C) vs. hypothermia (27°C). In addition, at 27°C, the CPR for 3-h provided global O2 delivery (DO2) to support aerobic metabolism. The present study investigated if rewarming with closed thoracic lavage induces a perfusing rhythm after 3-h continuous CPR at 27°C.Materials and Methods: Eight male pigs were anesthetized, and immersion-cooled. At 27°C, HCA was electrically induced, CPR was started and continued for a 3-h period. Thereafter, the animals were rewarmed by combining closed thoracic lavage and continued CPR. Organ blood flow was measured using microspheres.Results: After cooling with spontaneous circulation to 27°C, MAP and CO were initially reduced by 37 and 58% from baseline, respectively. By 15 min after the onset of CPR, MAP, and CO were further reduced by 58 and 77% from baseline, respectively, which remained unchanged throughout the rest of the 3-h period of CPR. During CPR at 27°C, DO2 and O2 extraction rate (VO2) fell to critically low levels, but the simultaneous small increase in lactate and a modest reduction in pH, indicated the presence of maintained aerobic metabolism. During rewarming with closed thoracic lavage, all animals displayed ventricular fibrillation, but only one animal could be electro-converted to restore a short-lived perfusing rhythm. Rewarming ended in circulatory collapse in all the animals at 38°C.Conclusion: The CPR for 3-h at 27°C managed to sustain lower levels of CO and MAP sufficient to support global DO2. Rewarming accidental hypothermia patients following prolonged CPR for HCA with closed thoracic lavage is not an alternative to rewarming by extra-corporeal life support as these patients are often in need of massive cardio-pulmonary support during as well as after rewarming.

Sign in / Sign up

Export Citation Format

Share Document