Neurologic Recovery After Cardiac Arrest: a Multifaceted Puzzle Requiring Comprehensive Coordinated Care

Maciel, Carolina B.; Barden, Mary M.; Greer, David M.

doi:10.1007/s11936-017-0548-0

Cited by 14 publications

(28 citation statements)

References 151 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…For this reason, 15 years back we focused our research onto the limitation of this generalized IRI of the whole body and the brain. The therapeutic CARL approach represents an evolved method that aims towards a limitation of a generalized IRI and follows the current highly demanded concept of tCPR (4,18,22,26). CARL allows for a rationale-based, personalized and comprehensive therapy based on a readily available set of monitoring data and diagnostic findings.…”

Section: Discussionmentioning

confidence: 99%

“…"Targeted CPR" (tCPR) is a relatively new concept, where during the resuscitative efforts specific hemodynamic, respiratory and metabolic targets are defined (4-7). Among others, compression depth of cardiac massage, arterial blood pressure, end-tidal CO 2 measurement and the titration of oxygen are core elements of tCPR (4,8). Although tCPR represents a logical step towards a rationale based and controlled therapeutic approach in CPR, due to a significant lack of available appropriate monitoring and related therapeutic interventions, the implementation of tCPR remains rudimentary (9).…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Controlled automated reperfusion of the whole body after cardiac arrest

Trummer¹,

Benk²,

Beyersdorf³

2019

J. Thorac. Dis

View full text Add to dashboard Cite

Background: Sudden circulatory arrest (CA) requiring cardiopulmonary resuscitation (CPR) has for decades been associated with high mortality and frequent neurological sequelae in the rarer survivors. The high mortality and morbidity are potentially related to a severe and global ischemia/reperfusion injury (IRI) of the whole body, especially the brain. Consequently, strategies to counteract this severe IRI may improve survival and neurological recovery of affected patients. Methods: Based on the target to limit IRI in single organs, suitable parameters and methods were composed to form a global treatment concept, the CARL method (controlled automated reperfusion of the whole body). The concept centers on extracorporeal circulation, enhanced with readily available online monitoring. It allows for targeted adaption of different parameters (i.e., blood pressure and flow, temperature, oxygen content, electrolytes) during the reperfusion process, in the sense of a controlled reperfusion. Parameters and elements of the CARL method were extensively tested in a chronic animal model. An appropriate medical device, the system configuration "CIRD 1.0" (Controlled Integrated Resuscitation Device) is approved to be applied to patients. Results: A set of parameters that support a limitation of a global IRI have been identified in over 250 animal experiments. Their specific targets and surveillance using adequate monitoring features are described. Using the CIRD in a single center, 14 patients with witnessed, but extremely prolonged CPR (51-120 minutes) have been treated with CARL. The outcome of these patients was favorable, with 7 of 14 patients regaining full consciousness and 6 of 7 allocated to Cerebral Performance Class (CPC) "1". Conclusions: CA followed by CPR is associated with a very high mortality and frequent neurological sequelae. Limiting the occurring severe and global IRI may be a key to an improved survival and neurological recovery. Therefore, the therapeutic approach of CARL, which stands for a personalized, comprehensive therapy based on a readily available set of monitoring data and diagnostic findings, has been developed. First experience in patients indicates beneficial effects that call for further studies in the field of CARL.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Controlled automated reperfusion of the whole body after cardiac arrest

Trummer¹,

Benk²,

Beyersdorf³

2019

J. Thorac. Dis

View full text Add to dashboard Cite

show abstract

“…However, we know from cases where life-sustaining treatment was not withdrawn, that false positives do occur, even with the most reliable tests. 21 viii If there are indeed false positives, they remain hidden after WLST due to the epistemic challenge of SFPs. We now describe three ways in which these hidden errors can persist through various iterations of prognostic innovation.…”

Section: Three Ways That the Sfp Distorts Prognostic Researchmentioning

confidence: 99%

“…They continue, 'even findings considered infallible in predicting poor outcome…have lost their immaculate prognostic ability, although they continue to have very low false positive rates.' 21 somatosensory evoked potentials (SSEP) test. If one of the established test results is positive, even if it is a false positive, the ensuing poor prognosis justifies (perhaps even demands) WLST.…”

Section: Three Ways That the Sfp Distorts Prognostic Researchmentioning

confidence: 99%

Can we learn from hidden mistakes? Self-fulfilling prophecy and responsible neuroprognostic innovation

et al. 2021

View full text Add to dashboard Cite

A self-fulfilling prophecy (SFP) in neuroprognostication occurs when a patient in coma is predicted to have a poor outcome, and life-sustaining treatment is withdrawn on the basis of that prediction, thus directly bringing about a poor outcome (viz. death) for that patient. In contrast to the predominant emphasis in the bioethics literature, we look beyond the moral issues raised by the possibility that an erroneous prediction might lead to the death of a patient who otherwise would have lived. Instead, we focus on the problematic epistemic consequences of neuroprognostic SFPs in settings where research and practice intersect. When this sort of SFP occurs, the problem is that physicians and researchers are never in a position to notice whether their original prognosis was correct or incorrect, since the patient dies anyway. Thus, SFPs keep us from discerning false positives from true positives, inhibiting proper assessment of novel prognostic tests. This epistemic problem of SFPs thus impedes learning, but ethical obligations of patient care make it difficult to avoid SFPs. We then show how the impediment to catching false positive indicators of poor outcome distorts research on novel techniques for neuroprognostication, allowing biases to persist in prognostic tests. We finally highlight a particular risk that a precautionary bias towards early withdrawal of life-sustaining treatment may be amplified. We conclude with guidelines about how researchers can mitigate the epistemic problems of SFPs, to achieve more responsible innovation of neuroprognostication for patients in coma.

show abstract

“…

Sudden cardiac arrest is the most common cause of death worldwide. 1,2 Though high-quality cardiopulmonary resuscitation (CPR) has improved survival after cardiac arrest, 1 more than 80% of survivors remain comatose after return of spontaneous circulation (ROSC) secondary to hypoxic ischemic injury. 3 Since the advent of targeted temperature management (TTM), neurologic recovery has improved substantially, 1,4,5 but the majority of survivors have ongoing neurologic deficits ranging from minor cognitive impairment to persistent coma.

…”

mentioning

confidence: 99%

Neuroprognostication after Cardiac Arrest: Who Recovers? Who Progresses to Brain Death?

Carroll

Lewis

2021

Semin Neurol

View full text Add to dashboard Cite

Approximately 15% of deaths in developed nations are due to sudden cardiac arrest, making it the most common cause of death worldwide. Though high-quality cardiopulmonary resuscitation has improved overall survival rates, the majority of survivors remain comatose after return of spontaneous circulation secondary to hypoxic ischemic injury. Since the advent of targeted temperature management, neurologic recovery has improved substantially, but the majority of patients are left with neurologic deficits ranging from minor cognitive impairment to persistent coma. Of those who survive cardiac arrest, but die during their hospitalization, some progress to brain death and others die after withdrawal of life-sustaining treatment due to anticipated poor neurologic prognosis. Here, we discuss considerations neurologists must make when asked, “Given their recent cardiac arrest, how much neurologic improvement do we expect for this patient?”

show abstract

Neurologic Recovery After Cardiac Arrest: a Multifaceted Puzzle Requiring Comprehensive Coordinated Care

Cited by 14 publications

References 151 publications

Controlled automated reperfusion of the whole body after cardiac arrest

Controlled automated reperfusion of the whole body after cardiac arrest

Can we learn from hidden mistakes? Self-fulfilling prophecy and responsible neuroprognostic innovation

Neuroprognostication after Cardiac Arrest: Who Recovers? Who Progresses to Brain Death?

Contact Info

Product

Resources

About