Review
Cardiac & Cardiovascular Systems
Johannes Grand, Christian Hassager
Summary: Out-of-hospital cardiac arrest is a major cause of death. Bystander response with CPR and the use of AEDs have improved survival rates. In-hospital treatment focuses on emergency angiography and temperature control. A multimodal prognostication model is key for patients without awakening. Follow-up with screening for disabilities is recommended. Research on cardiac arrest has evolved significantly over the years and larger trials with improved methodology are being conducted. This article discusses the evolution and future perspectives in post-cardiac arrest care.
EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE
(2023)
Review
Biochemistry & Molecular Biology
Adeleh Sahebnasagh, Farhad Najmeddin, Atabak Najafi, Fatemeh Saghafi, Amin Sale-hi-Abargouei, Arezoo Ahmadi, Shahideh Amini, Mojtaba Mojtahedzadeh, Hamidreza Sharifnia
Summary: Glucocorticoid supplementation during and after CPR may have beneficial effects on survival-to-admission, survival-to-discharge, and 1-year survival rates in patients with cardiac arrest, but there is limited evidence and inconsistent results to establish a correlation. More high-quality, large-scale studies are needed to evaluate the exact dose, duration, and efficacy of glucocorticoids in cardiac arrest.
CURRENT MEDICINAL CHEMISTRY
(2022)
Review
Critical Care Medicine
Cody A. Cunningham, Patrick J. Coppler, Aaron B. Skolnik
Summary: Post-cardiac arrest syndrome (PCAS) is a condition that affects multiple organ systems, including brain injury, myocardial dysfunction, and systemic ischemia-reperfusion injury. The immune system plays a crucial role in PCAS, and potential therapies need to be administered early and provide comprehensive cytoprotection. This narrative review discusses the dysregulated immune response in PCAS, human trials of targeted immunomodulation therapies, and future directions for immunomodulation following cardiac arrest.
Article
Critical Care Medicine
Tae Youn Kim, Sung Oh Hwang, Woo Jin Jung, Young Il Roh, Soyeong Kim, Hyun Kim, Kyoung-Chul Cha
Summary: The Patient State Index (PSI) and suppression ratio (SR) show promise as reliable predictors for early neuro-prognostication in post-cardiac arrest patients undergoing targeted temperature management. Monitoring these parameters can help guide medical interventions and predict outcomes.
JOURNAL OF CRITICAL CARE
(2021)
Article
Medicine, General & Internal
Christoph Schriefl, Christian Schoergenhofer, Florian Ettl, Michael Poppe, Christian Clodi, Matthias Mueller, Juergen Grafeneder, Bernd Jilma, Ingrid Anna Maria Magnet, Nina Buchtele, Magdalena Sophie Boegl, Michael Holzer, Fritz Sterz, Michael Schwameis
Summary: In the early post-cardiac arrest period, increasing hemoglobin levels despite positive fluid balance may serve as a surrogate parameter of vascular permeability and are associated with poor neurologic function.
FRONTIERS IN MEDICINE
(2021)
Article
Critical Care Medicine
Rongrong Shen, Dong Pan, Zhengquan Wang, Xiaohong Jin, Zilong Li, Haojie Wang
Summary: Dexmedetomidine post-conditioning demonstrated significant improvement in cardiac and neurological outcomes post-resuscitation by reducing tissue inflammation, oxidative stress, and cell apoptosis and necroptosis. The protective effects were dose-dependent, with the high-dose group showing greater benefits compared to the low-dose group.
Article
Critical Care Medicine
Jerry P. Nolan, Claudio Sandroni, Bernd W. Boettiger, Alain Cariou, Tobias Cronberg, Hans Friberg, Cornelia Genbrugge, Kirstie Haywood, Gisela Lilja, Veronique R. M. Moulaert, Nikolaos Nikolaou, Theresa Mariero Olasveengen, Markus B. Skrifvars, Fabio Taccone, Jasmeet Soar
Summary: The guidelines cover a wide range of topics related to post-resuscitation care for adult patients, including diagnosis, treatment, monitoring, and management, as well as prognosis assessment, long-term recovery, and organ donation.
INTENSIVE CARE MEDICINE
(2021)
Review
Medicine, General & Internal
Kazuya Kikutani, Mitsuaki Nishikimi, Tatsutoshi Shimatani, Michihito Kyo, Shinichiro Ohshimo, Nobuaki Shime
Summary: Current research suggests that hypothermic targeted temperature management (TTM) may not be superior to normothermic TTM in improving neurological outcomes in post-cardiac arrest syndrome (PCAS) patients. However, studies indicate that the efficacy of hypothermic TTM may vary based on the severity of PCAS, suggesting the potential for individualized treatment approaches.
JOURNAL OF CLINICAL MEDICINE
(2021)
Article
Cardiac & Cardiovascular Systems
Lauge Vammen, Cecilie Munch Johannsen, Andreas Magnussen, Amalie Povlsen, Soren Riis Petersen, Arezo Azizi, Bo Lofgren, Lars W. Andersen, Asger Granfeldt
Summary: This study developed a pig model of cardiac arrest with myocardial infarction, targeted temperature management, and clinically relevant post-cardiac arrest care. Two methods of inducing myocardial ischemia were demonstrated, resulting in post-cardiac arrest organ injury including cardiac dysfunction and cerebral injury.
JOURNAL OF THE AMERICAN HEART ASSOCIATION
(2021)
Article
Pharmacology & Pharmacy
Jiefeng Xu, Minhai Zhang, Fei Liu, Lin Shi, Xiangkang Jiang, Chuang Chen, Jiangang Wang, Mengyuan Diao, Zafar Ullah Khan, Mao Zhang
Summary: The study demonstrated that mesenchymal stem cells (MSCs) could alleviate post-resuscitation cardiac and cerebral injuries in swine by inhibiting cell pyroptosis and ferroptosis. Both CPR and MSC groups showed worse outcomes compared to the sham group, with the MSC group exhibiting milder cardiac and cerebral damage.
FRONTIERS IN PHARMACOLOGY
(2021)
Article
Cardiac & Cardiovascular Systems
Jens Agerstrom, Magnus Carlsson, Anders Bremer, Johan Herlitz, Johan Israelsson, Kristofer Arestedt
Summary: This study revealed clear socioeconomic status differences in treatment and survival following in-hospital cardiac arrest, with higher SES patients being more likely to receive and survive emergency measures. This suggests that patients with low SES might be subject to discrimination.
EUROPEAN HEART JOURNAL
(2021)
Review
Critical Care Medicine
Fabrice I. Mowbray, Donna Manlongat, Rebecca H. Correia, Ryan P. Strum, Shannon M. Fernando, Daniel McIsaac, Kerstin de Wit, Andrew Worster, Andrew P. Costa, Lauren E. Griffith, Matthew Douma, Jerry P. Nolan, John Muscedere, Rachel Couban, Farid Foroutan
Summary: The synthesis of current evidence indicates that frailty is associated with increased in-hospital mortality, decreased incidence of ROSC, and lower likelihood of discharge home following cardiac arrest. Frailty proves to be a robust prognostic factor that can inform decision-making and policies surrounding advance care directives.
Article
Biochemistry & Molecular Biology
Long Chen, Na Geng, Taiwei Chen, Qingqing Xiao, Hengyuan Zhang, Huanhuan Huo, Lisheng Jiang, Qin Shao, Ben He
Summary: The study found that ginsenoside Rb1 (Gn-Rb1) has cardioprotective effects in cardiac remodeling and cardiac ischemia/reperfusion (I/R) injury. It was observed that Gn-Rb1 improved cardiac systolic function, reduced mortality rates, and improved neurological outcome after cardiopulmonary resuscitation (CPR). Further mechanistic investigations revealed that Gn-Rb1 protected against mitochondrial destabilization and oxidative stress through the activation of Keap1/Nrf2 signaling pathway.
INTERNATIONAL JOURNAL OF MOLECULAR SCIENCES
(2023)
Review
Cardiac & Cardiovascular Systems
Jun Wei Yeo, Zi Hui Celeste Ng, Amelia Xin Chun Goh, Jocelyn Fangjiao Gao, Nan Liu, Shao Wei Sean Lam, Yew Woon Chia, Gavin D. Perkins, Marcus Eng Hock Ong, Andrew Fu Wah Ho
Summary: This study found that care at cardiac arrest centers (CACs) was associated with improved survival and neurological outcomes for patients with nontraumatic out-of-hospital cardiac arrest. The benefits were consistent regardless of varying CAC definitions. Patients with shockable rhythms and those without prehospital return of spontaneous circulation benefited more from CACs. The evidence for bypassing hospitals or interhospital transfer remains inconclusive.
JOURNAL OF THE AMERICAN HEART ASSOCIATION
(2022)
Article
Critical Care Medicine
Filippo Annoni, Fuhong Su, Lorenzo Peluso, Ilaria Lisi, Enrico Caruso, Francesca Pischiutta, Elisa Gouvea Bogossian, Bruno Garcia, Hassane Njimi, Jean-Louis Vincent, Nicolas Gaspard, Lorenzo Ferlini, Jacques Creteur, Elisa R. R. Zanier, Fabio Silvio Taccone
Summary: Prognosis after resuscitation from cardiac arrest (CA) is poor, but hypertonic sodium lactate (HSL) infusion may have beneficial effects on brain and cardiac injury. This study aimed to test the effects of HSL infusion in an experimental model of CA.
Article
Critical Care Medicine
Veerle Heesters, Janneke Dekker, Timothy J. R. Panneflek, Kristel L. A. M. Kuypers, Stuart B. Hooper, Remco Visser, Arjan B. te Pas
Summary: This study visualized the closure of vocal cords during apnea, in between breaths, and during breath holds in preterm infants using ultrasonography. The closure of vocal cords impaired the effect of respiratory support.