Risk factors for progression toward brain death after out-of-hospital cardiac arrest

Cour, Martin; Turc, Jean; Madelaine, Thomas; Argaud, Laurent

doi:10.1186/s13613-019-0520-0

Cited by 18 publications

(8 citation statements)

References 24 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Age, non-cardiac etiology, and prolonged CPR also are associated with risk of brain death in other cohorts. 22 Blinding also could not affect the observed associations between clinical variables and early cerebral edema. Despite the limitations posed by lack of blinding and potential influence of scans on subsequent care, our data support the idea that severely abnormal CT scans provides some prognostic or injuryseverity information about cardiac arrest patients that may be useful to clinicians.…”

Section: Discussionmentioning

confidence: 95%

Duration and clinical features of cardiac arrest predict early severe cerebral edema

et al. 2020

View full text Add to dashboard Cite

Background: Severe brain edema appears early after cardiopulmonary resuscitation (CPR) in a subset of patients and portends a poor prognosis. We tested whether clinical features of patients or resuscitation during out-of-hospital cardiac arrest (OHCA) are associated with early, severe cerebral edema.Method/research design: We reviewed pre-hospital and hospital records for comatose patients surviving to hospital admission after OHCA who had computed tomography (CT) of brain at the time of hospital admission available for inspection. We measured the gray-white ratio (GWR) of X-ray attenuation between the caudate nucleus and posterior limb of the internal capsule, defining severe cerebral edema as GWR < 1.20. We calculated associations between severe cerebral edema and patient or resuscitation variables.Results: Between 2010 and 2019, 1340 subjects were admitted of whom 296 (22%) showed severe cerebral edema on initial CT. Subjects with severe edema had lower survival (5/296, 2% vs. 377/1044, 36%). Severe edema was independently associated with total CPR duration, total dose of epinephrine, younger age, non-shockable arrest rhythms, fewer total number of rescue shocks, rearrest after initial return of pulses, and non-cardiac arrest etiology.Prevalence of severe cerebral edema increased from 2% among subjects with 0À10 min of CPR to 31% among subjects with >40 min of CPR. Conclusion:CPR duration along with easily measurable clinical and resuscitation characteristics predict early severe cerebral edema after OHCA. Future interventional trials should consider targeting or preventing cerebral edema after prolonged hypoxic-ischemic brain injury especially in patients with high risk clinical features.

show abstract

Section: Discussionmentioning

confidence: 95%

Duration and clinical features of cardiac arrest predict early severe cerebral edema

et al. 2020

View full text Add to dashboard Cite

show abstract

“…Among patients with sustainable ROSC, intensive care unit (ICU) mortality remains high, ranging from 60% [ 2 , 3 ] to 80% [ 1 , 4 ] of patients. In-hospital mortality after OHCA mainly results from different causes including recurrent CA, irreversible anoxic brain damage (including brain death), as well as comorbid withdrawal of care [ 5 , 6 ]. In addition, a substantial proportion of these post-CA patients will suffer from a severe hemodynamic impairment that may worsen organ damages and may lead to death in the first hours or days.…”

Section: The Concept Of Post-resuscitation Shockmentioning

confidence: 99%

Post-resuscitation shock: recent advances in pathophysiology and treatment

Jozwiak

Bougouin

Géri

et al. 2020

Ann. Intensive Care

View full text Add to dashboard Cite

A post-resuscitation shock occurs in 50–70% of patients who had a cardiac arrest. It is an early and transient complication of the post-resuscitation phase, which frequently leads to multiple-organ failure and high mortality. The pathophysiology of post-resuscitation shock is complex and results from the whole-body ischemia–reperfusion process provoked by the sequence of circulatory arrest, resuscitation manoeuvers and return of spontaneous circulation, combining a myocardial dysfunction and sepsis features, such as vasoplegia, hypovolemia and endothelial dysfunction. Similarly to septic shock, the hemodynamic management of post-resuscitation shock is based on an early and aggressive hemodynamic management, including fluid administration, vasopressors and/or inotropes. Norepinephrine should be considered as the first-line vasopressor in order to avoid arrhythmogenic effects of other catecholamines and dobutamine is the most established inotrope in this situation. Importantly, the optimal mean arterial pressure target during the post-resuscitation shock still remains unknown and may probably vary according to patients. Mechanical circulatory support by extracorporeal membrane oxygenation can be necessary in the most severe patients, when the neurological prognosis is assumed to be favourable. Other symptomatic treatments include protective lung ventilation with a target of normoxia and normocapnia and targeted temperature management by avoiding the lowest temperature targets. Early coronary angiogram and coronary reperfusion must be considered in ST-elevation myocardial infarction (STEMI) patients with preserved neurological prognosis although the timing of coronary angiogram in non-STEMI patients is still a matter of debate. Further clinical research is needed in order to explore new therapeutic opportunities regarding inflammatory, hormonal and vascular dysfunction.

show abstract

“…Survival rate after cardiac arrest at hospital discharge in Europe is less than 10% with significant variation between different countries [4,5]. Furthermore, only less than 10% were discharges without any neurological deficits [6]. Two third of the patients who die after admission to an intensive care unit suffer from some neurological injuries, both before and after implementation of target temperature management (TTM) in 2002 [7].…”

Section: Discussionmentioning

confidence: 99%

Value Your Training and Don’t Lead Me into Temptation – Pitfalls in Neuroprognostication After Cardiac Arrest

Christian,

Barbara,

Patrick

2021

ACMCR

View full text Add to dashboard Cite

Risk factors for progression toward brain death after out-of-hospital cardiac arrest

Cited by 18 publications

References 24 publications

Duration and clinical features of cardiac arrest predict early severe cerebral edema

Duration and clinical features of cardiac arrest predict early severe cerebral edema

Post-resuscitation shock: recent advances in pathophysiology and treatment

Value Your Training and Don’t Lead Me into Temptation – Pitfalls in Neuroprognostication After Cardiac Arrest

Contact Info

Product

Resources

About