Cardiac arrest (CA) afflicts~550,000 people each year in the USA. A small fraction of CA sufferers survive with a majority of these survivors emerging in a comatose state. Many CA survivors suffer devastating global brain injury with some remaining indefinitely in a comatose state. The pathogenesis of global brain injury secondary to CA is complex. Mechanisms of CAinduced brain injury include ischemia, hypoxia, cytotoxicity, inflammation, and ultimately, irreversible neuronal damage. Due to this complexity, it is critical for clinicians to have access as early as possible to quantitative metrics for diagnosing injury severity, accurately predicting outcome, and informing patient care. Current recommendations involve using multiple modalities including clinical exam, electrophysiology, brain imaging, and molecular biomarkers. This multi-faceted approach is designed to improve prognostication to avoid "self-fulfilling" prophecy and early withdrawal of life-sustaining treatments. Incorporation of emerging dynamic monitoring tools such as diffuse optical technologies may provide improved diagnosis and early prognostication to better inform treatment. Currently, targeted temperature management (TTM) is the leading treatment, with the number of patients needed to treat being~6 in order to improve outcome for one patient. Future avenues of treatment, which may potentially be combined with TTM, include pharmacotherapy, perfusion/oxygenation targets, and pre/postconditioning. In this review, we provide a bench to bedside approach to delineate the pathophysiology, prognostication methods, current targeted therapies, and future directions of research surrounding hypoxic-ischemic brain injury (HIBI) secondary to CA.

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Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) primarily affects the respiratory system but can also lead to neurological complications. Among COVID-19 patients, the endothelium is considered the Achilles heel. A variety of endothelial dysfunctions may result from SARS-CoV-2 infection and subsequent endotheliitis, such as altered vascular tone, oxidative stress, and cytokine storms. The cerebral hemodynamic impairment that is caused is associated with a higher probability of severe disease and poor outcomes in patients with COVID-19. This review summarizes the most relevant literature on the role of vasomotor reactivity (VMR) in COVID-19 patients. An overview of the research articles is presented. Most of the studies have supported the hypothesis that endothelial dysfunction and cerebral VMR impairment occur in COVID-19 patients. Researchers believe these alterations may be due to direct viral invasion of the brain or indirect effects, such as inflammation and cytokines. Recently, researchers have concluded that viruses such as the Human Herpes Virus 8 and the Hantavirus predominantly affect endothelial cells and, therefore, affect cerebral hemodynamics. Especially in COVID-19 patients, impaired VMR is associated with a higher risk of severe disease and poor outcomes. Using VMR, one can gain valuable insight into a patient’s disease progression and make more informed decisions regarding appropriate treatment options. A new pandemic may develop with the COVID-19 virus or other viruses, making it essential that healthcare providers and researchers remain focused on developing new strategies for improving survival in such patients, particularly those with cerebrovascular risk factors.

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Echocardiographic Evaluation (FREE); a hybrid between an FCU and the quantitative anatomic assessment of standard transthoracic echocardiogram (TTE). We sought to compare the data provided by the FREE and TTE, and determine the impact of the FREE on the plan of care.Methods: The FREE exam evaluates cardiac function (left ventricle ejection fraction (EF), diastolic dysfunction (E, E/ A, E'), RV function, cardiac output, preload (LV internal dimension end diastole (LVID)), stroke volume (SV), stroke volume variation (SVV), IVC and IVC collapse. Using clinical data and defined critical care algorithm, treatment recommendations are made. We identified patients who underwent both a TTE and FREE, on same day, from January 2012 through May 2014. Bland Altmann and Pearson correlation analysis were used to assess for agreement. Clinical utility was prospectively determined by provider survey immediately following the FREE, as part of its Q/A database.Results: Over the study period 849 FREE exams were performed. 69 patient exams met inclusion criteria. EF between groups showed a strong correlation (R5 0.89, 95% CI 0.82-0.93). Anatomic measures of LVOT, LVID, E and Lateral E' also showed strong correlation (R50.84, R50.94, R50.77, R50.68 respectively). RV function was able to be assessed in 85% of patinets and agreed in 88% of these. Pericardial effusion evaluation agreed in 93% of patients. Aortic and mitral valve anatomy agreed in almost all patients assessed (100%, 98%). The FREE changed care in 53%, confirmed management 23%, and was found not useful in 23% of patients.Conclusions: Functional rather than anatomically based hybrid ultrasound exams, like the FREE, provide data in a format designed to facilitate decision making in the ICU. These exams can be reliably performed by the bedside intensivist, correlate well with TTE, and may be of greater clinical value in critically ill patients. Further work is needed to determine universal applicability of these findings.