Cerebrovascular Cytokine Responses During Coronary Artery Bypass Surgery: Specific Production of Interleukin-8 and Its Attenuation by Hypothermic Cardiopulmonary Bypass

Nandate, Koichiro; Vuylsteke, Alain; Crosbie, Alan E.; Messahel, Souad; Oduro-Dominah, Amo; Menon, David

doi:10.1097/00000539-199910000-00003

Cited by 19 publications

(15 citation statements)

References 19 publications

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“…37,41,[43][44][45] Hypothermia is thought to play a neuroprotective role after ROSC by decreasing metabolic demand, 46,47 decreasing the release of excitatory neurotransmitters, 16 and decreasing inflammation. 48 Animal studies since the 1980s [49][50][51][52][53][54][55][56][57] have suggested that mild induced hypothermia may be beneficial as a neuroprotectant after cardiac arrest. In addition, human literature describes a beneficial effect of mild induced hypothermia in resuscitated post cardiac arrest patients.…”

Section: Discussionmentioning

confidence: 99%

Systematic review of randomized controlled trials of therapeutic hypothermia as a neuroprotectant in post cardiac arrest patients

Cheung

Green

Magee

2006

CJEM

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Objective: Several randomized controlled trials have suggested that mild induced hypothermia may improve neurologic outcome in comatose cardiac arrest survivors. This systematic review of randomized controlled trials was designed to determine if mild induced hypothermia improves neurologic outcome, decreases mortality, or is associated with an increased incidence of adverse events. Science (1989 to November 2005. For each included study, references were reviewed and the primary author contacted to identify any additional studies. Study selection: Studies that met inclusion criteria were randomized controlled trials of adult patients (>18 years of age) with primary cardiac arrest who remained comatose after return of spontaneous circulation. Patients had to be randomized to mild induced hypothermia (32°C-34°C) or normothermia within 24 hours of presentation. Only studies reporting pre-determined outcomes including discharge neurologic outcome, mortality or significant treatment-related adverse events were included. There were no language or publication restrictions. Data synthesis: Four studies involving 436 patients, with 232 cooled to a core temperature of 32°C-34°C met inclusion criteria. Pooled data demonstrated that mild hypothermia decreased inhospital mortality (relative ratio [RR] 0.75; 95% confidence interval [CI], 0.62-0.92) and reduced the incidence of poor neurologic outcome (RR 0.74; 95% CI, 0.62-0.84). Numbers needed to treat were 7 patients to save 1 life, and 5 patients to improve neurologic outcome. There was no evidence of treatment-limiting side effects. Conclusions: Therapeutically induced mild hypothermia decreases in-hospital mortality and improves neurologic outcome in comatose cardiac arrest survivors. The possibility of treatment-limiting side effects cannot be excluded. RÉSUMÉObjectif : Plusieurs essais comparatifs randomisés ont suggéré qu'une légère hypothermie provoquée peut améliorer le résultat clinique chez les victimes d'arrêt cardiaque dans le coma. La

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Section: Discussionmentioning

confidence: 99%

Systematic review of randomized controlled trials of therapeutic hypothermia as a neuroprotectant in post cardiac arrest patients

Cheung

Green

Magee

2006

CJEM

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“…None of these complications resulted in worsened outcome, and all were easy to manage. Although hypothermia is theorized to suppress immune response, 22 the rate of patients with pneumonia (5 of 9) was not higher than expected in comatose CA patients.…”

Section: Safetymentioning

confidence: 76%

“…The mechanism by which hypothermia conveys its neuroprotective effects is unclear, but hypothermia decreases metabolic demand, 20 decreases release of extracellular glutamate and other neurotoxic transmitters, 21 suppresses inflammation, 22 and stabilizes cell membranes. 23 To date, few preliminary reports have evaluated post-CA neuroprotective hypothermia in humans.…”

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confidence: 99%

Hypothermia After Cardiac Arrest

et al. 2001

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Background-No proven neuroprotective treatment exists for ischemic brain injury after cardiac arrest. Mild-to-moderate induced hypothermia (MIH) is effective in animal models. Methods and Results-A safety and feasibility trial was designed to evaluate mild-to-moderate induced hypothermia by use of external cooling blankets after cardiac arrest. Inclusion criteria were return of spontaneous circulation within 60 minutes of advanced cardiac life support, hypothermia initiated within 90 minutes, persistent coma, and lack of acute myocardial infarction or unstable dysrhythmia. Hypothermia to 33°C was maintained for 24 hours followed by passive rewarming. Nine patients were prospectively enrolled. Mean time from advanced cardiac life support to return of spontaneous circulation was 11 minutes (range 3 to 30); advanced cardiac life support to initiation of hypothermia was 78 minutes (range 40 to 109); achieving 33°C took 301 minutes (range 90 to 690). Three patients completely recovered, and 1 had partial neurological recovery. One patient developed unstable cardiac dysrhythmia. No other unexpected complications occurred. Conclusions-Mild-to-moderate induced hypothermia after cardiac arrest is feasible and safe. However, external cooling is slow and imprecise. Efforts to speed the start of cooling and to improve the cooling process are needed. (Circulation.

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“…31,32 Whether cerebral inflammatory processes occur as a result of CPB is not clear. 33,34 The common link between temperature and outcome might relate to an inflammatory process initiated during CPB that causes the brain injury and an independent hyperthermia, which then further exacerbates that injury. So in effect, this association that we have described may be both cause and effect.…”

Section: Discussionmentioning

confidence: 99%

Postoperative Hyperthermia Is Associated With Cognitive Dysfunction After Coronary Artery Bypass Graft Surgery

Grocott¹,

Mackensen²,

Grigore³

et al. 2002

Stroke

175

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Background and Purpose-Temperature is a well-known modulator of experimental cerebral injury. We hypothesized that hyperthermia would be associated with a worsened cognitive outcome after coronary artery bypass graft surgery (CABG). Methods-Three hundred consenting patients undergoing cardiopulmonary bypass for CABG had hourly postoperative temperatures recorded. The degree of postoperative hyperthermia was determined by using the maximum temperature within the first 24 hours as well as by calculating the area under the curve for temperatures Ͼ37°C. Patients underwent a battery of cognitive testing both before surgery and 6 weeks after surgery. By use of factor analysis, 4 cognitive domains (scores) were identified, and the mean of the 4 scores was used to calculate the cognitive index (CI). Cognitive change was calculated as the 6-week CI minus the baseline CI. Multivariable linear regression (controlling for age, baseline cognitive function, and temperature during cardiopulmonary bypass) was used to compare postoperative hyperthermia with the postoperative cognitive change. Results-The maximum temperature within the first 24 hours after CABG ranged from 37.2°C to 39.3°C. There was no relationship between area under the curve for temperatures Ͼ37°C and cognitive dysfunction (Pϭ0.45). However, the maximum postoperative temperature was associated with a greater amount of cognitive dysfunction at 6 weeks (Pϭ0.05). Conclusions-This is the first report relating postoperative hyperthermia to cognitive dysfunction after cardiac surgery.Whether the hyperthermia caused the worsened outcome or whether processes that resulted in the worsened cognitive outcome also produced hyperthermia requires further investigation. In addition, interventions to avoid postoperative hyperthermia may be warranted to improve cerebral outcome after cardiac surgery. (Stroke. 2002;33:537-541.)

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Cerebrovascular Cytokine Responses During Coronary Artery Bypass Surgery: Specific Production of Interleukin-8 and Its Attenuation by Hypothermic Cardiopulmonary Bypass

Cited by 19 publications

References 19 publications

Systematic review of randomized controlled trials of therapeutic hypothermia as a neuroprotectant in post cardiac arrest patients

Systematic review of randomized controlled trials of therapeutic hypothermia as a neuroprotectant in post cardiac arrest patients

Hypothermia After Cardiac Arrest

Postoperative Hyperthermia Is Associated With Cognitive Dysfunction After Coronary Artery Bypass Graft Surgery

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