Brain injury after cardiac arrest

Perkins, Gavin D; Callaway, Clifton W.; Haywood, Kirstie L.; Neumar, Robert W.; Lilja, Gisela; Rowland, Matthew; Sawyer, Kelly N.; Skrifvars, Markus B.; Nolan, Jerry P.

doi:10.1016/s0140-6736(21)00953-3

Cited by 129 publications

(105 citation statements)

References 79 publications

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“…It can also demonstrate the relationship between treatment Fig. 2 Risk of bias assessment for the included studies using the updated Cochrane RoB2 tool for randomised trials [23]. For each of the bias domains, the risk was classified as 'low risk' , 'some concerns' or 'high risk' .…”

Section: Discussionmentioning

confidence: 99%

“…Survival (primary outcome) and neurological status (secondary outcome) using the definitions in the original studies were censored within up to 180 days after cardiac arrest. Most neurocognitive recovery occurs within the first 90–180 days timeframe [ 22 , 23 ] that has commonly been used in RCTs of TTM. Short-term neurological outcome, e.g.…”

Section: Methodsmentioning

confidence: 99%

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Target temperature management following cardiac arrest: a systematic review and Bayesian meta-analysis

et al. 2022

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Background Temperature control with target temperature management (TTM) after cardiac arrest has been endorsed by expert societies and adopted in international clinical practice guidelines but recent evidence challenges the use of hypothermic TTM. Methods Systematic review and Bayesian meta-analysis of clinical trials on adult survivors from cardiac arrest undergoing TTM for at least 12 h comparing TTM versus no TTM or with a separation > 2 °C between intervention and control groups using the PubMed/MEDLINE, EMBASE, CENTRAL databases from inception to 1 September 2021 (PROSPERO CRD42021248140). All randomised and quasi-randomised controlled trials were considered. The risk ratio and 95% confidence interval for death (primary outcome) and unfavourable neurological recovery (secondary outcome) were captured using the original study definitions censored up to 180 days after cardiac arrest. Bias was assessed using the updated Cochrane risk-of-bias for randomised trials tool and certainty of evidence assessed using the Grading of Recommendation Assessment, Development and Evaluation methodology. A hierarchical robust Bayesian model-averaged meta-analysis was performed using both minimally informative and data-driven priors and reported by mean risk ratio (RR) and its 95% credible interval (95% CrI). Results In seven studies (three low bias, three intermediate bias, one high bias, very low to low certainty) recruiting 3792 patients the RR by TTM 32–34 °C was 0.95 [95% CrI 0.78—1.09] for death and RR 0.93 [95% CrI 0.84—1.02] for unfavourable neurological outcome. The posterior probability for no benefit (RR ≥ 1) by TTM 32–34 °C was 24% for death and 12% for unfavourable neurological outcome. The posterior probabilities for favourable treatment effects of TTM 32–34 °C were the highest for an absolute risk reduction of 2–4% for death (28–53% chance) and unfavourable neurological outcome (63–78% chance). Excluding four studies without active avoidance of fever in the control arm reduced the probability to achieve an absolute risk reduction > 2% for death or unfavourable neurological outcome to ≤ 50%. Conclusions The posterior probability distributions did not support the use of TTM at 32–34 °C compared to 36 °C also including active control of fever to reduce the risk of death and unfavourable neurological outcome at 90–180 days. Any likely benefit of hypothermic TTM is smaller than targeted in RCTs to date.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Target temperature management following cardiac arrest: a systematic review and Bayesian meta-analysis

et al. 2022

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“…Out‐of‐hospital cardiac arrest (OHCA) is a leading cause of global mortality and disability 1,2 . Despite advances in the field of resuscitation, rates of survival in patients treated with conventional cardiopulmonary resuscitation (C‐CPR) remain low and many survivors have persistent neurological damage 3 . Chances of survival after OHCA start to decline rapidly after 10 min of C‐CPR 4 .…”

Section: Introductionmentioning

confidence: 99%

Extracorporeal cardiopulmonary resuscitation for out‐of‐hospital cardiac arrest: A systematic review and meta‐analysis of randomized and propensity score‐matched studies

et al. 2022

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Background:In selected patients with refractory out-of-hospital cardiac arrest, extracorporeal cardiopulmonary resuscitation represents a promising approach when conventional cardiopulmonary resuscitation fails to achieve return of spontaneous circulation. This systematic review and meta-analysis aimed to compare extracorporeal cardiopulmonary resuscitation to conventional cardiopulmonary resuscitation. Methods: We searched PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials up to November 28, 2021, for randomized trials and observational studies reporting propensity score-matched data and comparing adults with out-of-hospital cardiac arrest treated with extracorporeal cardiopulmonary resuscitation with those treated with conventional cardiopulmonary resuscitation. The primary outcome was survival with favorable neurological outcome at the longest follow-up available. Secondary outcomes were survival at the longest follow-up available and survival at hospital discharge/30 days. Results: We included six studies, two randomized and four propensity scorematched studies. Patients treated with extracorporeal cardiopulmonary resuscitation had higher rates of survival with favorable neurological outcome (81/584 [14%] vs. 46/593 [7.8%]; OR = 2.11; 95% CI, 1.41-3.15; p < 0.001, number needed to treat 16) and of survival (131/584 [22%] vs. 102/593 [17%]; OR = 1.40; 95% CI, 1.05-1.87; p = 0.02) at the longest follow-up available compared with conventional cardiopulmonary resuscitation. Survival at hospital discharge/30 days was similar between the two groups (142/584 [24%] vs. 122/593 [21%]; OR = 1.26; 95% CI, 0.95-1.66; p = 0.10). Conclusions: Evidence from randomized trials and propensity score-matched studies suggests increased survival and favorable neurological outcome in patients with refractory out-of-hospital cardiac arrest treated with extracorporeal

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“…Several mechanisms have been suggested to explain post–resuscitation cerebral injury and the therapeutic targets ( Stub et al, 2011 ; Sekhon et al, 2017 ). However, a majority of therapies that target the amelioration of cerebral injury in post–cardiac arrest syndrome (PCAS) have proven unsuccessful, and targeted temperature management remains the only effective treatment ( Nolan et al, 2008 ; Choudhary et al, 2021 ; Perkins et al, 2021 ; Sandroni et al, 2021 ).…”

Section: Introductionmentioning

confidence: 99%

Vagus Nerve Stimulation Improves Mitochondrial Dysfunction in Post–cardiac Arrest Syndrome in the Asphyxial Cardiac Arrest Model in Rats

et al. 2022

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Cerebral mitochondrial dysfunction during post–cardiac arrest syndrome (PCAS) remains unclear, resulting in a lack of therapeutic options that protect against cerebral ischemia–reperfusion injury. We aimed to assess mitochondrial dysfunction in the hippocampus after cardiac arrest and whether vagus nerve stimulation (VNS) can improve mitochondrial dysfunction and neurological outcomes. In an asphyxial cardiac arrest model, male Sprague–Dawley rats were assigned to the vagus nerve isolation (CA) or VNS (CA + VNS) group. Cardiopulmonary resuscitation was performed 450 s after pulseless electrical activity. After the return of spontaneous circulation (ROSC), left cervical VNS was performed for 3 h in the CA + VNS group. Mitochondrial respiratory function was evaluated using high-resolution respirometry of the hippocampal tissue. The neurologic deficit score (NDS) and overall performance category (OPC) were assessed at 24, 48, and 72 h after resuscitation. The leak respiration and oxidative phosphorylation capacity of complex I (OXPHOS CI) at 6 h after ROSC were significantly higher in the CA + VNS group than in the CA group (p = 0.0308 and 0.0401, respectively). Compared with the trends of NDS and OPC in the CA group, the trends of those in the CA + VNS group were significantly different, thus suggesting a favorable neurological outcome in the CA + VNS group (p = 0.0087 and 0.0064 between times × groups interaction, respectively). VNS ameliorated mitochondrial dysfunction after ROSC and improved neurological outcomes in an asphyxial cardiac arrest rat model.

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Brain injury after cardiac arrest

Cited by 129 publications

References 79 publications

Target temperature management following cardiac arrest: a systematic review and Bayesian meta-analysis

Target temperature management following cardiac arrest: a systematic review and Bayesian meta-analysis

Extracorporeal cardiopulmonary resuscitation for out‐of‐hospital cardiac arrest: A systematic review and meta‐analysis of randomized and propensity score‐matched studies

Vagus Nerve Stimulation Improves Mitochondrial Dysfunction in Post–cardiac Arrest Syndrome in the Asphyxial Cardiac Arrest Model in Rats

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