Bedside microdialysis for detection of early brain injury after out-of-hospital cardiac arrest

Mölström, Simon; Nielsen, Troels Halfeld; Nordstrom, Carl; Forsse, Axel; Möller, Sören; Venø, Søren; Mamaev, Dmitry; Tencer, Tomáš; Schmidt, Henrik; Toft, Palle

doi:10.1038/s41598-021-95405-9

Cited by 10 publications

(17 citation statements)

References 42 publications

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“…As a product of tissue hypoxia, lactate itself can be used as an indicator of tissue hypoperfusion. Clinically, the determination of serum lactate plays a very important role in guiding the treatment of patients with ischemic injury, especially in the treatment of tissue hypoxia and ischemia-reperfusion injury caused by cerebral ischemia and insufficient blood flow in patients with myocardial infarction 212 – 215 . In addition, lactate is considered to be a predictor of major complications after cardiac surgery 216 , 217 , the significance of blood lactate measurement in monitoring the progress of cardiac surgery has been clarified.…”

Section: Roles Of Lactic Acid In Pathophysiological Processesmentioning

confidence: 99%

Lactate metabolism in human health and disease

Yang

Zhang

et al. 2022

Sig Transduct Target Ther

451

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The current understanding of lactate extends from its origins as a byproduct of glycolysis to its role in tumor metabolism, as identified by studies on the Warburg effect. The lactate shuttle hypothesis suggests that lactate plays an important role as a bridging signaling molecule that coordinates signaling among different cells, organs and tissues. Lactylation is a posttranslational modification initially reported by Professor Yingming Zhao’s research group in 2019. Subsequent studies confirmed that lactylation is a vital component of lactate function and is involved in tumor proliferation, neural excitation, inflammation and other biological processes. An indispensable substance for various physiological cellular functions, lactate plays a regulatory role in different aspects of energy metabolism and signal transduction. Therefore, a comprehensive review and summary of lactate is presented to clarify the role of lactate in disease and to provide a reference and direction for future research. This review offers a systematic overview of lactate homeostasis and its roles in physiological and pathological processes, as well as a comprehensive overview of the effects of lactylation in various diseases, particularly inflammation and cancer.

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Section: Roles Of Lactic Acid In Pathophysiological Processesmentioning

confidence: 99%

Lactate metabolism in human health and disease

Yang

Zhang

et al. 2022

Sig Transduct Target Ther

451

234

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“…However, microdialysis findings were similar between the groups, and this suggest no alleviation of cerebral ischemia. 45 …”

Section: Discussionmentioning

confidence: 99%

Hemodynamic evaluation by serial right heart catheterizations after cardiac arrest; protocol of a sub-study from the Blood Pressure and Oxygenation Targets after Out-of-Hospital Cardiac Arrest-trial (BOX)

et al. 2021

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Background Neurological injury and mortality remain high in comatose patients resuscitated from out-of-hospital cardiac arrest (OHCA). Hypotension and hypoxia during post-resuscitation care have been associated with poor outcome, but the optimal oxygenation- and blood pressure-targets are unknown. The impact of different doses of norepinephrine on advanced hemodynamic after OHCA and the impact of different oxygenation-targets on pulmonary circulation and resistance (PVR), are unknown. The aims of this substudy of the “Blood pressure and oxygenations targets after out-of-hospital cardiac arrest (BOX)”-trial are to investigate the effect of two different MAP- and oxygenation-targets on advanced systemic and pulmonary hemodynamics measured by pulmonary artery catheters (PAC). Methods The BOX-trial is an investigator-initiated, randomized, controlled study comparing targeted MAP of 63 mmHg vs 77 mmHg (double-blinded intervention) and 9–10 kPa versus PaO2 of 13–14 kPa oxygenation-targets (open-label). Per protocol, all patients will be monitored systematically with PACs. The primary endpoint of the hemodynamic-substudy is cardiac output for the MAP-intervention, and PVR for the oxygenation-intervention. For both endpoints, the difference within 48 h between groups are assessed. Secondary endpoints are pulmonary capillary wedge pressure and pulmonary arterial pressure and association between advanced hemodynamic variables and mortality and biomarkers of inflammation and brain injury. Discussion In the BOX-trial, patients will be randomly allocated to two levels of MAP and oxygenation, which are central parts of post-resuscitation care and where evidence is sparse. The advanced-hemodynamic substudy will give valuable knowledge of the hemodynamic consequences of changing blood pressure and oxygen-levels of the critical cardiac patient. It will be one of the largest clinical, prospective trials of advanced hemodynamics measured by serial PACs in consecutive comatose patients, resuscitated after OHCA. The randomized and placebo-controlled trialdesign of the MAP-intervention minimizes risk of selection bias and confounders. Furthermore, hemodynamic characteristics and associations with outcome will be investigated. Trial registration ClinicalTrials.gov (ClinicalTrials.gov Identifier: NCT03141099). Registered March 30, 2017.

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“…A feasibility study was designed to investigate if bedside JBMD reflected secondary deterioration of cerebral energy metabolism after OHCA and whether it might be implemented as a clinical tool for early evaluation of prognosis and individualization of treatment ( 107 ). To document whether JBMD reflected intracerebral energy state the primary objective of the study was to compare time-averaged means of lactate, pyruvate and LP ratio (intervals of 12 h) of the jugular venous and the arterial blood during post-resuscitation care.…”

Section: Microdialysis Of Cerebral Venous Blood—clinicalmentioning

confidence: 99%

“…Eighteen unconscious patients with sustained return of spontaneous circulation (ROSC) after OHCA were included in the study ( 107 ). JBM and near-infrared spectroscopy monitoring were the sole modifications from international clinical treatment guidelines for comatose OHCA patients.…”

Section: Microdialysis Of Cerebral Venous Blood—clinicalmentioning

confidence: 99%

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Bedside interpretation of cerebral energy metabolism utilizing microdialysis in neurosurgical and general intensive care

et al. 2022

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The microdialysis technique was initially developed for monitoring neurotransmitters in animals. In 1995 the technique was adopted to clinical use and bedside enzymatic analysis of glucose, pyruvate, lactate, glutamate and glycerol. Under clinical conditions microdialysis has also been used for studying cytokines, protein biomarkers, multiplex proteomic and metabolomic analyses as well as for pharmacokinetic studies and evaluation of blood-brain barrier function. This review focuses on the variables directly related to cerebral energy metabolism and the possibilities and limitations of microdialysis during routine neurosurgical and general intensive care. Our knowledge of cerebral energy metabolism is to a large extent based on animal experiments performed more than 40 years ago. However, the different biochemical information obtained from various techniques should be recognized. The basic animal studies analyzed brain tissue homogenates while the microdialysis technique reflects the variables in a narrow zone of interstitial fluid surrounding the probe. Besides the difference of the volume investigated, the levels of the biochemical variables differ in different compartments. During bedside microdialysis cerebral energy metabolism is primarily reflected in measured levels of glucose, lactate and pyruvate and the lactate to pyruvate (LP) ratio. The LP ratio reflects cytoplasmatic redox-state which increases instantaneously during insufficient aerobic energy metabolism. Cerebral ischemia is characterized by a marked increase in intracerebral LP ratio at simultaneous decreases in intracerebral levels of pyruvate and glucose. Mitochondrial dysfunction is characterized by a moderate increase in LP ratio at a very marked increase in cerebral lactate and normal or elevated levels of pyruvate and glucose. The patterns are of importance in particular for interpretations in transient cerebral ischemia. A new technique for evaluating global cerebral energy metabolism by microdialysis of the draining cerebral venous blood is discussed. In experimental studies it has been shown that pronounced global cerebral ischemia is reflected in venous cerebral blood. Jugular bulb microdialysis has been investigated in patients suffering from subarachnoid hemorrhage, during cardiopulmonary bypass and resuscitation after out of hospital cardiac arrest. Preliminary results indicate that the new technique may give valuable information of cerebral energy metabolism in clinical conditions when insertion of an intracerebral catheter is contraindicated.

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Bedside microdialysis for detection of early brain injury after out-of-hospital cardiac arrest

Cited by 10 publications

References 42 publications

Lactate metabolism in human health and disease

Lactate metabolism in human health and disease

Hemodynamic evaluation by serial right heart catheterizations after cardiac arrest; protocol of a sub-study from the Blood Pressure and Oxygenation Targets after Out-of-Hospital Cardiac Arrest-trial (BOX)

Bedside interpretation of cerebral energy metabolism utilizing microdialysis in neurosurgical and general intensive care

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