Focus on post-resuscitation care

Sandroni, Claudio; Nolan, Jerry P.

doi:10.1007/s00134-019-05666-2

Cited by 9 publications

(9 citation statements)

References 14 publications

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“…Many patients resuscitated from out-of-hospital cardiac arrest (OHCA) suffer from hypoxic-ischaemic brain injury (HIBI) and die in the intensive care unit (ICU) without regaining consciousness [1,2]. Accurate prognostication is of paramount importance to prevent prolonged futile intensive care and, on the other hand, to avoid withdrawal of care in those who have a chance to recover [3,4].…”

Section: Introductionmentioning

confidence: 99%

Neurofilament light as an outcome predictor after cardiac arrest: a post hoc analysis of the COMACARE trial

et al. 2020

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Purpose: Neurofilament light (NfL) is a biomarker reflecting neurodegeneration and acute neuronal injury, and an increase is found following hypoxic brain damage. We assessed the ability of plasma NfL to predict outcome in comatose patients after out-of-hospital cardiac arrest (OHCA). We also compared plasma NfL concentrations between patients treated with two different targets of arterial carbon dioxide tension (PaCO 2), arterial oxygen tension (PaO 2), and mean arterial pressure (MAP). Methods: We measured NfL concentrations in plasma obtained at intensive care unit admission and at 24, 48, and 72 h after OHCA. We assessed neurological outcome at 6 months and defined a good outcome as Cerebral Performance Category (CPC) 1-2 and poor outcome as CPC 3-5. Results: Six-month outcome was good in 73/112 (65%) patients. Forty-eight hours after OHCA, the median NfL concentration was 19 (interquartile range [IQR] 11-31) pg/ml in patients with good outcome and 2343 (587-5829) pg/ml in those with poor outcome, p < 0.001. NfL predicted poor outcome with an area under the receiver operating characteristic curve (AUROC) of 0.98 (95% confidence interval [CI] 0.97-1.00) at 24 h, 0.98 (0.97-1.00) at 48 h, and 0.98 (0.95-1.00) at 72 h. NfL concentrations were lower in the higher MAP (80-100 mmHg) group than in the lower MAP (65-75 mmHg) group at 48 h (median, 23 vs. 43 pg/ml, p = 0.04). PaCO 2 and PaO 2 targets did not associate with NfL levels. Conclusions: NfL demonstrated excellent prognostic accuracy after OHCA. Higher MAP was associated with lower NfL concentrations.

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Section: Introductionmentioning

confidence: 99%

Neurofilament light as an outcome predictor after cardiac arrest: a post hoc analysis of the COMACARE trial

et al. 2020

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“…HIBI is characterized by multiple mechanisms that occur in parallel, such as failure of microcirculation, no-reflow cerebral edema, tissue hypoxia ( 2 ), elevated intracranial pressure, and dysfunctional cerebral autoregulation ( 3 , 4 ). As such, maintaining adequate CBF and cerebral oxygen delivery is paramount in post-resuscitation care ( 5 ). However, studies in patients following cardiac arrest demonstrate that the autoregulatory plateau is narrowed and right-shifted, with marked between-patient heterogeneity ( 4 , 6 , 7 ).…”

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confidence: 99%

Near-Infrared Spectroscopy to Assess Cerebral Autoregulation and Optimal Mean Arterial Pressure in Patients With Hypoxic-Ischemic Brain Injury: A Prospective Multicenter Feasibility Study

Griesdale

Sekhon

Wood

et al. 2020

Critical Care Explorations

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“…2 Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles (ULB), Brussels, Belgium. 3 Emergency Medical Services of the Hradec Kralove Region, Hradec Králové, Czech Republic. 4 Department of Anaesthesiology and Intensive Care Medicine, University Hospital Hradec Králové, Hradec Králové, Czech Republic.…”

Section: Electronic Supplementary Materialsmentioning

confidence: 99%

“…Severe brain injury remains the primary cause of death in resuscitated cardiac arrest patients, while the strategies currently available to improve neurologic outcome are limited [1][2][3][4][5]. Therapeutic hypothermia reduces ischemia-reperfusion brain injury after cardiac arrest by a number of mechanisms in experimental models [6].…”

Section: Introductionmentioning

confidence: 99%

Time to intra-arrest therapeutic hypothermia in out-of-hospital cardiac arrest patients and its association with neurologic outcome: a propensity matched sub-analysis of the PRINCESS trial

et al. 2020

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Purpose: To study the association between early initiation of intra-arrest therapeutic hypothermia and neurologic outcome in out-of-hospital cardiac arrest. Methods:A prespecified sub-analysis of the PRINCESS trial (NCT01400373) that randomized 677 bystanderwitnessed cardiac arrests to transnasal evaporative intra-arrest cooling initiated by emergency medical services or cooling started after hospital arrival. Early cooling (intervention) was defined as intra-arrest cooling initiated < 20 min from collapse (i.e., ≤ median time to cooling in PRINCESS). Propensity score matching established comparable control patients. Primary outcome was favorable neurologic outcome, Cerebral Performance Category (CPC) 1-2 at 90 days. Complete recovery (CPC 1) was among secondary outcomes.Results: In total, 300 patients were analyzed and the proportion with CPC 1-2 at 90 days was 35/150 (23.3%) in the intervention group versus 24/150 (16%) in the control group, odds ratio (OR) 1.92, 95% confidence interval (CI) 0.95-3.85, p = .07. In patients with shockable rhythm, CPC 1-2 was 29/57 (50.9%) versus 17/57 (29.8%), OR 3.25, 95%, CI 1.06-9.97, p = .04. The proportion with CPC 1 at 90 days was 31/150 (20.7%) in the intervention group and 17/150 (11.3%) in controls, OR 2.27, 95% CI 1.12-4.62, p = .02. In patients with shockable rhythms, the proportion with CPC 1 was 27/57 (47.4%) versus 12/57 (21.1%), OR 5.33, 95% CI 1.55-18.3, p = .008. Conclusions:In the whole study population, intra-arrest cooling initiated < 20 min from collapse compared to cooling initiated at hospital was not associated with improved favorable neurologic outcome. In the subgroup with shockable rhythms, early cooling was associated with improved favorable outcome and complete recovery.

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Focus on post-resuscitation care

Cited by 9 publications

References 14 publications

Neurofilament light as an outcome predictor after cardiac arrest: a post hoc analysis of the COMACARE trial

Neurofilament light as an outcome predictor after cardiac arrest: a post hoc analysis of the COMACARE trial

Near-Infrared Spectroscopy to Assess Cerebral Autoregulation and Optimal Mean Arterial Pressure in Patients With Hypoxic-Ischemic Brain Injury: A Prospective Multicenter Feasibility Study

Time to intra-arrest therapeutic hypothermia in out-of-hospital cardiac arrest patients and its association with neurologic outcome: a propensity matched sub-analysis of the PRINCESS trial

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