Post-cardiac arrest syndrome: Epidemiology, pathophysiology, treatment, and prognostication: A Scientific Statement from the International Liaison Committee on Resuscitation; the American Heart Association Emergency Cardiovascular Care Committee; the Council on Cardiovascular Surgery and Anesthesia; the Council on Cardiopulmonary, Perioperative, and Critical Care; the Council on Clinical Cardiology; the Council on Stroke (Part II)

Nolan, Jerry P.; Neumar, Robert W.; Adrie, Christophe; Aibiki, Mayuki; Berg, Robert A.; Bbttiger, Bernd W.; Callaway, Clifton W.; Clark, Robert S. B.; Geocadin, Romergryko G.; Jauch, Edward C.; Kern, Karl B.; Laurent, Isabelle; Longstreth, W. T.; Merchant, Raina M.; Morley, Peter; Morrison, Laurie J.; Nadkarni, Vinay; Peberdy, Mary Ann; Rivers, Emanuel P.; Núñez, Antonio Rodríguez; Sellke, Frank W.; Spaulding, Christian; Sunde, Kjetil; Hoek, Terry L. Vanden

doi:10.1016/j.ienj.2009.07.001

Cited by 200 publications

(274 citation statements)

References 368 publications

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“…Post-resuscitation care in the PICU consisted of prevention of secondary neurologic insults, treatment of organ dysfunction, and investigation of cause of CA if unknown 23 . Standards of care for most children post-CA included intubation and mechanical ventilation and placement of central venous and arterial catheters.…”

Section: Methodsmentioning

confidence: 99%

Serum Biomarkers of Brain Injury to Classify Outcome After Pediatric Cardiac Arrest*

Fink

Berger

Clark

et al. 2014

Critical Care Medicine

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Objective Morbidity and mortality in children with cardiac arrest (CA) largely result from neurologic injury. Serum biomarkers of brain injury can potentially measure injury to neurons (neuron specific enolase [NSE]), astrocytes (S100b), and axons (myelin basic protein [MBP]). We hypothesized that serum biomarkers can be used to predict outcome from pediatric CA. Design Prospective observational study. Setting Single tertiary pediatric hospital. Patients Forty-three children with cardiac arrest. Interventions None. Measurements and Main Results We measured serum NSE, S100b, and MBP on days 1–4 and 7 after CA. We recorded demographics, details of the CA and resuscitation, and Pediatric Cerebral Performance Category (PCPC) at hospital discharge and 6 months. We analyzed the association of biomarker levels at 24, 48, and 72 hours with good (PCPC 1–3) or poor (PCPC 4–6) outcome and mortality. Forty-three children (49% female; mean age of 5.9 ± 6.3 were enrolled and 17 (40%) died. Serum concentration at 24 hours for all 3 biomarkers predicted mortality (all p<0.05). Additionally, serum NSE and S100b concentrations were increased in the poor outcome vs. good outcome group and in subjects who died at all time points (all p<0.05). Receiver operator curves for serum S100b and NSE to predict good vs. poor outcome at 6 months was superior to clinical predictors. There was no association between serum biomarker concentrations and subject temperature. Conclusions Preliminary data show that serum S100b, NSE, and MBP may aid in outcome prediction of children surviving CA.

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Section: Methodsmentioning

confidence: 99%

Serum Biomarkers of Brain Injury to Classify Outcome After Pediatric Cardiac Arrest*

Fink

Berger

Clark

et al. 2014

Critical Care Medicine

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“…Sudden cardiac arrest is a cause of substantial mortality and morbidity that affects more than one million individuals worldwide every year [1]. Early prognostication of neurological outcome after successful cardiopulmonary resuscitation using clinical examination alone is difficult and has become more complicated with the introduction of therapeutic hypothermia as a treatment strategy for comatose cardiac arrest patients.…”

Section: Introductionmentioning

confidence: 99%

The brain-enriched microRNA miR-124 in plasma predicts neurological outcome after cardiac arrest

et al. 2014

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IntroductionEarly prognostication after successful cardiopulmonary resuscitation is difficult, and there is a need for novel methods to estimate the extent of brain injury and predict outcome. In this study, we evaluated the impact of the cardiac arrest syndrome on the plasma levels of selected tissue-specific microRNAs (miRNAs) and assessed their ability to prognosticate death and neurological disability.MethodsWe included 65 patients treated with hypothermia after cardiac arrest in the study. Blood samples were obtained at 24 hours and at 48 hours. For miRNA-screening purposes, custom quantitative polymerase chain reaction (qPCR) panels were first used. Thereafter individual miRNAs were assessed at 48 hours with qPCR. miRNAs that successfully predicted prognosis at 48 hours were further analysed at 24 hours. Outcomes were measured according to the Cerebral Performance Category (CPC) score at 6 months after cardiac arrest and stratified into good (CPC score 1 or 2) or poor (CPC scores 3 to 5).ResultsAt 48 hours, miR-146a, miR-122, miR-208b, miR-21, miR-9 and miR-128 did not differ between the good and poor neurological outcome groups. In contrast, miR-124 was significantly elevated in patients with poor outcomes compared with those with favourable outcomes (P < 0.0001) at 24 hours and 48 hours after cardiac arrest. Analysis of receiver operating characteristic curves at 24 and 48 hours after cardiac arrest showed areas under the curve of 0.87 (95% confidence interval (CI) = 0.79 to 0.96) and 0.89 (95% CI = 0.80 to 0.97), respectively.ConclusionsThe brain-enriched miRNA miR-124 is a promising novel biomarker for prediction of neurological prognosis following cardiac arrest.

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“…14 This describes a complex set of pathophysiological processes consisting of brain injury, myocardial depression, and systemic ischemia/reperfusion injury, as well as ongoing injury caused by the precipitating cause of the arrest. 15,16 The severity of each of the above is not uniform and varies across individuals.…”

Section: Pathophysiology Of Post Cardiac Arrest Syndromementioning

confidence: 99%

Out of Hospital Cardiac Arrest: A Current Review of the Literature that Informed the 2015 American Heart Association Guidelines Update

Milan

Perman

2016

Curr Emerg Hosp Med Rep

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Out-of-Hospital cardiac arrest affects over 300,000 individuals in the US per year and is the third leading cause of death for Americans. Given the extent of this public health problem, investigations are ongoing to improve upon outcomes for patients who suffer cardiac arrest. In 2015, the American Heart Association issued an update to the 2010 Cardiopulmonary and Emergency Cardiovascular Care Guidelines.1 In this manuscript, we reviewed the literature that informed the major changes to the guidelines and present a concise review of the current literature that informs how patients who suffer a cardiac arrest are cared for in the pre-hospital, emergency department and in-hospital environment. Additionally, the new AHA guideline on Maternal Resuscitation will also be described.

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Abstract: A growing body of knowledge suggests that the individual components of the post-cardiac arrest syndrome are potentially treatable.

Cited by 200 publications

References 368 publications

Serum Biomarkers of Brain Injury to Classify Outcome After Pediatric Cardiac Arrest*

Serum Biomarkers of Brain Injury to Classify Outcome After Pediatric Cardiac Arrest*

The brain-enriched microRNA miR-124 in plasma predicts neurological outcome after cardiac arrest

Out of Hospital Cardiac Arrest: A Current Review of the Literature that Informed the 2015 American Heart Association Guidelines Update

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