A Systematic Review of Neuroprotective Strategies during Hypovolemia and Hemorrhagic Shock

Abstract

Severe trauma constitutes a major cause of death and disability, especially in younger patients. The cerebral autoregulatory capacity only protects the brain to a certain extent in states of hypovolemia; thereafter, neurological deficits and apoptosis occurs. We therefore set out to investigate neuroprotective strategies during haemorrhagic shock. This review was performed in accordance to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Before the start of the search, a review protocol was entered into the PROSPERO database. A systematic literature search of Pubmed, Web of Science and CENTRAL was performed in August 2017. Results were screened and evaluated by two researchers based on a previously prepared inclusion protocol. Risk of bias was determined by use of SYRCLE’s risk of bias tool. The retrieved results were qualitatively analysed. Of 9093 results, 119 were assessed in full-text form, 16 of them ultimately adhered to the inclusion criteria and were qualitatively analyzed. We identified three subsets of results: (1) hypothermia; (2) fluid therapy and/or vasopressors; and (3) other neuroprotective strategies (piracetam, NHE1-inhibition, aprotinin, human mesenchymal stem cells, remote ischemic preconditioning and sevoflurane). Overall, risk of bias according to SYRCLE’s tool was medium; generally, animal experimental models require more rigorous adherence to the reporting of bias-free study design (randomization, etc.). While the individual study results are promising, the retrieved neuroprotective strategies have to be evaluated within the current scientific context—by doing so, it becomes clear that specific promising neuroprotective strategies during states of haemorrhagic shock remain sparse. This important topic therefore requires more in-depth research.

Altered Cerebral Blood Flow and Potential Neuroprotective Effect of Human Relaxin-2 (Serelaxin) During Hypoxia or Severe Hypovolemia in a Sheep Model

“…While the hypothesis that serelaxin might be beneficial in acute heart failure was proved wrong [12,13], serelaxin exhibits no negative impact on hemodynamic effects under normal conditions or during hypoxia or hypovolemia [14][15][16]. Currently, there is a lack of specific neuroprotective strategies for hypovolemia [17].…”

Underlying mechanism of subcortical brain protection during hypoxia and reoxygenation in a sheep model - Influence of α1-adrenergic signalling

“…Neurological deficits and impairments are in many cases accompanied by a significant decrease in the patients' quality of life and capability to uphold their former lifestyle, both in regard to private and work-related matters. Since the brain is especially vulnerable to ischemia [ 1 ], a variety of medical emergencies can lead to global ischemia and result in neurological damages, for example trauma [ 2 – 4 ], cardiac arrest [ 1 ], cerebral stroke [ 5 ] and (albeit rarer) traumatic asphyxia [ 6 , 7 ]. Secondary damage of the brain cells can furthermore occur due to reperfusion injury [ 8 ].…”

Effect of nanoparticles on gouty arthritis: a systematic review and meta-analysis

“…SYRCLE’s RoB tool was used to assess the risk of bias of included studies on animal experiments, the following results were obtained [ 34 ]: 100% of the included studies reported baseline characteristics, none of the studies provided details about sequence generation or allocation concealment, 100% reported information about random housing, 100% showed a low risk of bias in performance blinding, 10.0% of the included studies showed an unclear risk of bias in random outcome assessment, 70.0% showed a low risk of bias in detection blinding, 80.0% of studies showed a low risk of bias in incomplete outcome data, 100% showed a low risk of bias in selective outcome reporting, and none of the included studies reported other sources of bias.…”