BACKGROUND: Induced mild hypothermia (32-34 degrees C) has proven to reduce ischemic brain injury and improve outcome after a cardiac arrest (CA). The aim of this investigation was to study the occurrence of increased intracranial pressure (ICP) and neurochemical metabolic changes indicating cerebral ischemia, after CA and cardiopulmonary resuscitation (CPR), when induced hypothermia was applied. METHODS: ICP, brain chemistry and brain temperature were monitored during induced hypothermia and re-warming in four adult unconscious patients with restoration of spontaneous circulation after CA and CPR. RESULTS: ICP was occasionally above 20 mmHg. Neurochemical changes indicating cerebral ischemia (increased lactate/pyruvate ratio) and excitoxicity (increased glutamate) were found after CA, and signs of ischemia were also observed during the re-warming phase. A biphasic increase in glycerol was seen, which may have been a result of both membrane degradation and overspill from the general circulation. CONCLUSIONS: Intracerebral microdialysis and ICP monitoring may be used in selected patients not requiring anticoagulants and PCI to obtain information regarding the common disturbances of intracranial dynamics after CA. The results of this study underline the importance of inducing hypothermia quickly after CA and emphasize the need for developing tools for guidance of the re-warming.
BACKGROUND: Induced mild hypothermia (32-34 degrees C) has proven to reduce ischemic brain injury and improve outcome after a cardiac arrest (CA). The aim of this investigation was to study the occurrence of increased intracranial pressure (ICP) and neurochemical metabolic changes indicating cerebral ischemia, after CA and cardiopulmonary resuscitation (CPR), when induced hypothermia was applied. METHODS: ICP, brain chemistry and brain temperature were monitored during induced hypothermia and re-warming in four adult unconscious patients with restoration of spontaneous circulation after CA and CPR. RESULTS: ICP was occasionally above 20 mmHg. Neurochemical changes indicating cerebral ischemia (increased lactate/pyruvate ratio) and excitoxicity (increased glutamate) were found after CA, and signs of ischemia were also observed during the re-warming phase. A biphasic increase in glycerol was seen, which may have been a result of both membrane degradation and overspill from the general circulation. CONCLUSIONS: Intracerebral microdialysis and ICP monitoring may be used in selected patients not requiring anticoagulants and PCI to obtain information regarding the common disturbances of intracranial dynamics after CA. The results of this study underline the importance of inducing hypothermia quickly after CA and emphasize the need for developing tools for guidance of the re-warming.
Authors: Pedro Kurtz; Jan Claassen; J Michael Schmidt; Raimund Helbok; Khalid A Hanafy; Mary Presciutti; Hector Lantigua; E Sander Connolly; Kiwon Lee; Neeraj Badjatia; Stephan A Mayer Journal: Neurocrit Care Date: 2013-12 Impact factor: 3.210
Authors: A Hosmann; A Schober; A Gruber; F Sterz; C Testori; A Warenits; W Weihs; S Högler; T Scherer; A Janata; A Laggner; Markus Zeitlinger Journal: Neurocrit Care Date: 2016-04 Impact factor: 3.210
Authors: Lesley M Foley; Robert S B Clark; Alberto L Vazquez; T Kevin Hitchens; Henry Alexander; Chien Ho; Patrick M Kochanek; Mioara D Manole Journal: Pediatr Res Date: 2016-09-16 Impact factor: 3.756
Authors: Hyoung Youn Lee; Kamoljon Shamsiev; Najmiddin Mamadjonov; Yong Hun Jung; Kyung Woon Jeung; Jin Woong Kim; Tag Heo; Yong Il Min Journal: Int J Environ Res Public Health Date: 2021-05-31 Impact factor: 3.390
Authors: Mioara D Manole; Patrick M Kochanek; Hülya Bayır; Henry Alexander; Cameron Dezfulian; Ericka L Fink; Michael J Bell; Robert S B Clark Journal: Pediatr Res Date: 2013-11-13 Impact factor: 3.756