Strategies of Neuroprotection after Successful Resuscitation

Abstract

Post-cardiac arrest syndrome (PCAS) incorporates post-cardiac arrest brain injury, postcardiac arrest myocardial dysfunction, systemic ischemia/reperfusion syndrome and the precipitating pathology. Brain injury remains the leading cause of death in the postcardiac arrest period. One of our main goals during post-resuscitation care is to guide a proper neuroprotective strategy. We are going to summarize the tools of neuroprotection in post-cardiac arrest therapy. The role of normoxia/normocapnia, normoglycemia, seizure control, sedation and pharmacologic strategies will be discussed in brief. The handling of temperature management and the management of hemodynamic variables to secure satisfactory cerebral perfusion will be worked out in details. Targeted temperature management is the main tool of neuroprotection in post-cardiac arrest therapy. We are going to conclude the principles of temperature control after successful resuscitation pointing out its beneficial effects. This method has also several complications that are going to be discussed highlighting its hemodynamic impacts. There is no evidence about target hemodynamic parameters during post-cardiac arrest syndrome to maintain cerebral perfusion neither about the most effective hemodynamic monitoring system. We are presenting preliminary data of our study where we investigate the effect of PiCCO™ (Pulse index Continous Cardiac Output) monitoring on the outcome in this patient group.Keywords: post-cardiac arrest syndrome, post-cardiac arrest brain injury, post-resuscitation therapy, targeted temperature management, hemodynamic parameters IntroductionSudden cardiac arrest is one of the leading causes of death in Europe [1]. The outcome is still very poor: the hospital discharge varies between 7 and 10% after out-of-hospital cardiac arrest (OHCA) and it is approximately 25% after in-hospital cardiac arrest (IHCA) [1]. The chain of © 2017 The Author(s). Licensee InTech. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.survival describes links that lead to a successful resuscitation [2]. The fourth element covers proper post-resuscitation care to restore quality of life. It is well known that the management of post-resuscitation cardiac arrest syndrome affects outcome and it is an important part of the resuscitation process. Pointing out the growing importance of post-resuscitation therapy, the European Resuscitation Council (ERC) introduced a separate chapter about post-resuscitation care in the 2015 guidelines [3]. One of the key elements to improve survival rate after sudden cardiac arrest may be the enhancement of post-resuscitation therapy.The post-cardiac arrest brain injury remains the main cause of mortality in the post-cardiac arrest period, being as high as 68% after OHCA and 25% after IHCA [4]. These data show that one of our leading goa...

Hypothermia and its role in patients with ST-segment-elevation myocardial infarction and cardiac arrest

“…Besides therapeutic hypothermia and coronary revascularization, optimal intensive care unit management with regard to sedation and ventilation, blood glucose management, the prevention and adequate treatment of epileptic seizures, and pharmacological strategies is of utmost importance for improving outcomes in these critically ill patients (18,19). Targeted temperature management is the main neuroprotective tool in post-cardiac arrest therapy (18,19). Current and recent guidelines recommend a mild therapeutic hypothermia aiming a constant temperature between 32 and 36 • C for at least 24 h in patients who remain unconscious after CPR from cardiac arrest of presumed cardiac cause (2,(5)(6)(7)(8)22).…”

“…Patients who are unconscious after cardiac arrest are at substantial risk of death and developing neurological deficits ( 2 , 3 , 16 ). The post-cardiac arrest syndrome comprises different organ dysfunctions, including brain injury, myocardial dysfunction, and systemic ischemia/reperfusion syndrome ( 17 , 19 , 20 ). Brain injury is one of the most critical aspects and the leading cause of death in the post-cardiac arrest period ( 18 , 19 , 21 ).…”

“…The post-cardiac arrest syndrome comprises different organ dysfunctions, including brain injury, myocardial dysfunction, and systemic ischemia/reperfusion syndrome ( 17 , 19 , 20 ). Brain injury is one of the most critical aspects and the leading cause of death in the post-cardiac arrest period ( 18 , 19 , 21 ). Thus, neuroprotective strategies are crucial after successful out-of-hospital resuscitation of cardiac arrest patients.…”

“…Thus, neuroprotective strategies are crucial after successful out-of-hospital resuscitation of cardiac arrest patients. Besides therapeutic hypothermia and coronary revascularization, optimal intensive care unit management with regard to sedation and ventilation, blood glucose management, the prevention and adequate treatment of epileptic seizures, and pharmacological strategies is of utmost importance for improving outcomes in these critically ill patients ( 18 , 19 ). Targeted temperature management is the main neuroprotective tool in post-cardiac arrest therapy ( 18 , 19 ).…”

Célhőmérséklet a tartós újraélesztés utáni komplex intenzív kezelés során. Állásfoglalás az enyhe terápiás hypothermia mellett

“…Az O 2 -igény csökkentésében továbbá szerepe van az epileptikus aktivitás és a görcsrohamok elnyomásának is. A THT javasolt minden spontán keringésű, eszméletlen, VF miatt OHCA-t elszenvedett felnőtt betegnél; kevésbé erős evidenciával alátámasztottan a nem sokkolandó ritmusú, ugyancsak kómában maradt betegnél is alkalmazható [11]. Perman és mtsai 2015-ben mintegy 500 fős, nem sokkolandó ritmus miatt keringés-összeomlást elszenvedett betegpopuláción igazolták 'propensity matching'-et követő multivariáns analízissel, hogy a THT szignifikánsan jobb neurológiai kimenetellel, mortalitással járt együtt [12].…”