Brain injury after cardiac arrest: pathophysiology, treatment, and prognosis

Sandroni, Claudio; Cronberg, Tobias; Sekhon, Mypinder S.

doi:10.1007/s00134-021-06548-2

Cited by 246 publications

(192 citation statements)

References 145 publications

(220 reference statements)

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“…About 80% of patients who are successfully resuscitated from cardiac arrest are comatose on arrival at hospital [ 1 ] because of post-cardiac arrest brain injury (PCABI) [ 2 ], and their prognosis is uncertain. An accurate prediction of poor neurological outcome in these patients is important to avoid pursuing futile treatments in patients with irreversible PCABI.…”

Section: Introductionmentioning

confidence: 99%

Prediction of good neurological outcome in comatose survivors of cardiac arrest: a systematic review

et al. 2022

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Purpose: To assess the ability of clinical examination, blood biomarkers, electrophysiology or neuroimaging assessed within 7 days from return of spontaneous circulation (ROSC) to predict good neurological outcome, defined as no, mild, or moderate disability (CPC 1-2 or mRS 0-3) at discharge from intensive care unit or later, in comatose adult survivors from cardiac arrest (CA).Methods: PubMed, EMBASE, Web of Science and the Cochrane Database of Systematic Reviews were searched. Sensitivity and specificity for good outcome were calculated for each predictor. The risk of bias was assessed using the QUIPS tool.Results: A total of 37 studies were included. Due to heterogeneities in recording times, predictor thresholds, and definition of some predictors, meta-analysis was not performed. A withdrawal or localisation motor response to pain immediately or at 72-96 h after ROSC, normal blood values of neuron-specific enolase (NSE) at 24 h-72 h after ROSC, a short-latency somatosensory evoked potentials (SSEPs) N20 wave amplitude > 4 µV or a continuous background without discharges on electroencephalogram (EEG) within 72 h from ROSC, and absent diffusion restriction in the cortex or deep grey matter on MRI on days 2-7 after ROSC predicted good neurological outcome with more than 80% specificity and a sensitivity above 40% in most studies. Most studies had moderate or high risk of bias. Conclusions:In comatose cardiac arrest survivors, clinical, biomarker, electrophysiology, and imaging studies identified patients destined to a good neurological outcome with high specificity within the first week after cardiac arrest (CA).

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Section: Introductionmentioning

confidence: 99%

Prediction of good neurological outcome in comatose survivors of cardiac arrest: a systematic review

et al. 2022

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“…Menurut (Sandroni, 2021) Tingkat oksigen dalam darah di bawah 95% atau kondisi hipoksia merupakan prediktor cardiac arrest. Hipoksemia sistemik merupakan prediktor terhadap peningkatan cardiac arrest pasien.…”

Section: Pembahasanunclassified

Tingkat Oksigen Dalam Darah Terhadap Kejadian Cardiac Arrest Pada Pasien Cidera Kepala Berat

Santosa

Arisma

2022

AHNJ

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The most common causes of severe head injuries are motor vehicle accidents and falls from a height that cause cardiac arrest. Cardiac arrest resulted in the patient being unconscious, no breathing, and no pulse. The incidence of cardiac arrest is mostly because the patient is hypoxic. Patients with severe head injuries are characterized by a Gasglow Coma Scale (GCS) of 8 or less. Patients with severe head injuries who often have decreased oxygen saturation should require a definitive airway to prevent patient death. This study aims to determine the level of oxygen in the blood on the incidence of cardiac arrest in patients with severe head injury. The research was conducted at Gambiran Hospital, Kediri City. Correlational research with cross sectional approaches. The sample of this research is 18 respondents. The sampling technique is total sampling. The statistical test of this research is Spearman's rho. The results of this study p value = 0.035 which means p < (α = 0.05). There is a relationship between the level of oxygen in the blood and the incidence of cardiac arrest in patients with severe head injury. Keywords: Blood Oxygen Level, Cardiac arrest, Severe Head Injury.

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“…In Europe, 300,000 cardiac arrests occur annually, and more than 85% of CA cases result in death ( 4 ). Cardiac arrest associated central nervous injury is the main cause of death in patients resuscitated from cardiac arrest, and the main cause of long-term disability in those who survive the acute phase of resuscitation ( 5 , 6 ).…”

Section: Introductionmentioning

confidence: 99%

LncRNA GAS5/miR-137 Is a Hypoxia-Responsive Axis Involved in Cardiac Arrest and Cardiopulmonary Cerebral Resuscitation

et al. 2022

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BackgroundCardiac arrest/cardiopulmonary resuscitation (CA/CPR) represents one of the devastating medical emergencies and is associated with high mortality and neuro-disability. Post-cardiac arrest syndrome (PCAS) is mechanistically ascribed to acute systemic ischemia/reperfusion(I/R) injury. The lncRNA/microRNA/mRNA networks have been found to play crucial roles in the pathogenesis of the hypoxia-responsive diseases. Nonetheless, the precise molecular mechanisms by which lncRNA/miRNA/mRNA axes are involved in the astrocyte–microglia crosstalk in CA/CPR have not been fully elucidated.MethodsWe collected and purified the exosomes from the blood of CA/CPR patients and supernatant of OGD/R-stimulated astrocytes. On the basis of microarray analysis, bioinformatic study, and luciferase activity determination, we speculated that lncRNA GAS5/miR-137 is implicated in the astrocyte–microglia crosstalk under the insult of systemic I/R injury. The regulation of lncRNA GAS5/miR-137 on INPP4B was examined by cellular transfection in OGD/R cell culture and by lateral ventricle injection with miR-137 agomir in CA/CPR mice model. Flow cytometry and immunofluorescence staining were performed to detect the microglial apoptosis, M1/M2 phenotype transformation, and neuroinflammation. Neurological scoring and behavior tests were conducted in CA/CPR group, with miR-137 agomir lateral-ventricle infusion and in their controls.ResultsIn all the micRNAs, miR-137 was among the top 10 micRNAs that experienced greatest changes, in both the blood of CA/CPR patients and supernatant of OGD/R-stimulated astrocytes. Bioinformatic analysis revealed that miR-137 was sponged by lncRNA GAS5, targeting INPP4B, and the result was confirmed by Luciferase activity assay. qRT-PCR and Western blotting showed that lncRNA GAS5 and INPP4B were over-expressed whereas miR-137 was downregulated in the blood of CA/CPR patients, OGD/R-stimulated astrocytes, and brain tissue of CA/CPR mice. Silencing lncRNA GAS5 suppressed INPP4B expression, but over-expression of miR-137 negatively modulated its expression. Western blotting exhibited that PI3K and Akt phosphorylation was increased when lncRNA GAS5 was silenced or miR-137 was over-expressed. However, PI3K and Akt phosphorylation was notably suppressed in the absence of miR-137, almost reversing their phosphorylation in the silencing lncRNA GAS5 group. Then we found that GAS5 siRNA or miR-137 mimic significantly increased cell viability and alleviated apoptosis after OGD/R injury. Furthermore, over-expression of miR-137 attenuated microglial apoptosis and neuroinflammation in CA/CPR mice model, exhibiting significantly better behavioral tests after CA/CPR.ConclusionLncRNA GAS5/miR-137 may be involved in the astrocyte–microglia communication that inhibits PI3K/Akt signaling activation via regulation of INPP4B during CA/CPR.

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Brain injury after cardiac arrest: pathophysiology, treatment, and prognosis

Cited by 246 publications

References 145 publications

Prediction of good neurological outcome in comatose survivors of cardiac arrest: a systematic review

Prediction of good neurological outcome in comatose survivors of cardiac arrest: a systematic review

Tingkat Oksigen Dalam Darah Terhadap Kejadian Cardiac Arrest Pada Pasien Cidera Kepala Berat

LncRNA GAS5/miR-137 Is a Hypoxia-Responsive Axis Involved in Cardiac Arrest and Cardiopulmonary Cerebral Resuscitation

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