Inhaled nitric oxide in adults with in-hospital cardiac arrest: A feasibility study

Patel, Jignesh; Schoenfeld, Elinor; Hou, Wei; Singer, Adam J.; Rakowski, Ewa; Ahmad, Sahar; Patel, Rushi; Parikh, Puja B.; Smaldone, Gerald C.

doi:10.1016/j.niox.2021.07.001

Cited by 11 publications

(4 citation statements)

References 19 publications

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“…By contrast, when present, NO reduces injuries and has neuroprotective properties in ischemia/reperfusion animal models, both in relation to stroke and cardiac arrest [ 88 ]. For this reason, a prospective trial has been performed, proving the feasibility of iNO administration in cardiac arrest, and showing promising results in terms of survival [ 89 ]. In subarachnoid hemorrhage, NOS inactivation is associated with alterations in microvascular density and hemostasis, leading to rebleeding, intracranial hypertension, and larger hemorrhage volume [ 90 ].…”

Section: Reactive Nitrogen Speciesmentioning

confidence: 99%

Oxidative Stress and Cerebral Vascular Tone: The Role of Reactive Oxygen and Nitrogen Species

Salvagno,

Sterchele,

Zaccarelli

et al. 2024

IJMS

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The brain’s unique characteristics make it exceptionally susceptible to oxidative stress, which arises from an imbalance between reactive oxygen species (ROS) production, reactive nitrogen species (RNS) production, and antioxidant defense mechanisms. This review explores the factors contributing to the brain’s vascular tone’s vulnerability in the presence of oxidative damage, which can be of clinical interest in critically ill patients or those presenting acute brain injuries. The brain’s high metabolic rate and inefficient electron transport chain in mitochondria lead to significant ROS generation. Moreover, non-replicating neuronal cells and low repair capacity increase susceptibility to oxidative insult. ROS can influence cerebral vascular tone and permeability, potentially impacting cerebral autoregulation. Different ROS species, including superoxide and hydrogen peroxide, exhibit vasodilatory or vasoconstrictive effects on cerebral blood vessels. RNS, particularly NO and peroxynitrite, also exert vasoactive effects. This review further investigates the neuroprotective effects of antioxidants, including superoxide dismutase (SOD), vitamin C, vitamin E, and the glutathione redox system. Various studies suggest that these antioxidants could be used as adjunct therapies to protect the cerebral vascular tone under conditions of high oxidative stress. Nevertheless, more extensive research is required to comprehensively grasp the relationship between oxidative stress and cerebrovascular tone, and explore the potential benefits of antioxidants as adjunctive therapies in critical illnesses and acute brain injuries.

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Section: Reactive Nitrogen Speciesmentioning

confidence: 99%

Oxidative Stress and Cerebral Vascular Tone: The Role of Reactive Oxygen and Nitrogen Species

Salvagno,

Sterchele,

Zaccarelli

et al. 2024

IJMS

View full text Add to dashboard Cite

show abstract

“…In a pilot study including 20 adult IHCA patients receiving inhaled NO at a dose of 40 ppm immediately after ROSC for 24 hours and 199 IHCA controls [ 17 ], patients receiving NO had higher rates of survival to discharge compared to controls, yet no difference in the favorable neurologic outcome was observed. In a secondary analysis of phase I clinical trials including 82 adult OHCA patients, IV nitrite (25 mg or 60 mg) administration during resuscitation resulted in increased cyclic guanosine 3',5'-monophosphate (cGMP) and nitrated conjugated-linoleic acid (NO 2 -CLA) levels, which are responsible for nuclear factor erythroid 2–related factor 2 (Nrf2)-dependent antioxidant gene expression and inhibiting nuclear factor kappa B (NF-κB) regulated pro-inflammatory signaling.…”

Section: Neuroprotective Approaches In Ca-induced Brain Injurymentioning

confidence: 99%

Neuroprotective Approaches for Brain Injury After Cardiac Arrest: Current Trends and Prospective Avenues

Marasini,

Jia

2024

J Stroke

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With the implementation of improved bystander cardiopulmonary resuscitation techniques and public-access defibrillation, survival after out-of-hospital cardiac arrest (OHCA) has increased significantly over the years. Nevertheless, OHCA survivors have residual anoxia/reperfusion brain damage and associated neurological impairment resulting in poor quality of life. Extracorporeal membrane oxygenation or targeted temperature management has proven effective in improving post-cardiac arrest (CA) neurological outcomes, yet considering the substantial healthcare costs and resources involved, there is an urgent need for alternative treatment strategies that are crucial to alleviate brain injury and promote recovery of neurological function after CA. In this review, we searched PubMed for the latest preclinical or clinical studies (2016–2023) utilizing gas-mediated, pharmacological, or stem cell-based neuroprotective approaches after CA. Preclinical studies utilizing various gases (nitric oxide, hydrogen, hydrogen sulfide, carbon monoxide, argon, and xenon), pharmacological agents targeting specific CA-related pathophysiology, and stem cells have shown promising results in rodent and porcine models of CA. Although inhaled gases and several pharmacological agents have entered clinical trials, most have failed to demonstrate therapeutic effects in CA patients. To date, stem cell therapies have not been reported in clinical trials for CA. A relatively small number of preclinical stem-cell studies with subtle therapeutic benefits and unelucidated mechanistic explanations warrant the need for further preclinical studies including the improvement of their therapeutic potential. The current state of the field is discussed and the exciting potential of stem-cell therapy to abate neurological dysfunction following CA is highlighted.

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“…В 2019 г. J.K. Patel et al использовали ингаляции оксида азота у пациентов с внутрибольничной остановкой сердца. В пилотном исследовании ингаляции NO в концентрации 40 частей на миллион (ppm) в течение 24 ч в сочетании с гипотермией ассоциировались со значительно более высокими показателями выживаемости, но не влияли на неврологический исход [24]. [25].…”

Section: рациональная фармакотерапияunclassified

Inhaled nitric oxide: well-known and new therapeutic indications

Avdeev,

Tsareva,

Nekludova

et al. 2023

Medicinskij sovet

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The use of nitric oxide is widespread in medical practice. Inhaled form of NO in patients with respiratory disease is especially interesting. As an inhalation therapy, nitric oxide reaches well-ventilated areas of the lungs, having a negligible systemic effect due to its rapid inactivation in the bloodstream. It has long been known that inhaled NO improves oxygenation in various pathological conditions. Low doses of inhaled nitric oxide are known as a vasodilator in patients with pulmonary hypertension, its use is possible even in newborns with hypoxemic respiratory failure and persistent pulmonary hypertension. In turn, high doses are used in the treatment of infectious lung diseases, besides, another surge of scientific interest in nitric oxide arose during the coronavirus pandemic. Although the antimicrobial potential of nitric oxide is widely known, it is little used in clinical practice. Endogenous antimicrobial activity is largely mediated by high local concentrations of NO. Numerous preclinical studies have demonstrated that NO has general static and bactericidal activity against viruses, bacteria, protozoa and fungi/yeast in vitro. Due to the dose-dependent positive and negative effects of NO, safety and efficacy tests of NO and its donors are needed to assess their role in the prevention and treatment of infections. This review provides information on the chemical structure, features of metabolism and delivery of inhaled NO, and also pays special attention to the antimicrobial effect in various diseases of the pulmonological profile.

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Inhaled nitric oxide in adults with in-hospital cardiac arrest: A feasibility study

Cited by 11 publications

References 19 publications

Oxidative Stress and Cerebral Vascular Tone: The Role of Reactive Oxygen and Nitrogen Species

Oxidative Stress and Cerebral Vascular Tone: The Role of Reactive Oxygen and Nitrogen Species

Neuroprotective Approaches for Brain Injury After Cardiac Arrest: Current Trends and Prospective Avenues

Inhaled nitric oxide: well-known and new therapeutic indications

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