Abstract
Brain injury after cardiac arrest is a common cause of morbidity and mortality, hence the importance of understanding its pathophysiological mechanisms and its relation to the impact of resuscitation and prognosis of patients. The loss of cellular integrity triggers the release of glutamate thus generating excitotoxicity associated with the decreased of modulatory neurotransmitters levels and the elevation of intracellular calcium thense causing lesions in different brain areas and generating cognitive symptoms related to significant impact on quality of life. The Cerebral Performance Category is the gold standard for the assessment of neurological recovery after cardiopulmonary arrest (CPA) and neurological examination remains one of the most reliable factors to determine the extent of the injury and neurological outcome in CPA victims. Evidence shows that mild induced hypothermia may reduce injury, improving survival and functional neurologicals outcomes in comatose survivors of CPA. Brain injury after CPA is an important area for research.
References
ADABAG AS, LUEPKER RV, ROGER VL, GERSH BJ. Sudden cardiac death: epidemiology and risk factors. Nat Rev Cardiol. 2010; 7:216-25.
BRADY WJ, GURKA KK, MEHRING B, PEBERDY MA. In-hospital cardiac arrest: impact of monitoring and witnessed event on patient survival and neurologic status at hospital discharge. Resuscitation. 2011; 82:845-52.
DEATON C, FROELICHER ES, WU LH, HO C, SHISHANI K, JAARSMA T. The global burden of cardiovascular disease. Eur J Cardiovasc Nurs. 2011; 10(Suppl 2):5-14.
INAMASU J, MIYATAKE S, NAKATSUKASA M, KOH H, YAGAMI T. Loss of gray-white matter discrimination as an early CT sign of brain ischemia/ hypoxia in victims of asphyxial cardiac arrest. Emerg Radiol. 2011; 18:295-8.
INAMASU J, MIYATAKE S, SUZUKI M, NAKATSUKASA M, TOMIOKA H, HONDA M, ET AL. Early CT signs in out-of-hospital cardiac arrest survivors: Temporal profile and prognostic significance. Resuscitation. 2010; 81:534-8.
PAARMANN H, HERINGLAKE M, SIER H, SCHÖN J. The association of non-invasive cerebral and mixed venous oxygen saturation during cardiopulmonary resuscitation. Interact Cardiovasc Thorac Surg. 2010; 11:371-3.
MOULAERT VR, VERBUNT JA, VAN HEUGTEN CM, WADE DT. Cognitive impairments in survivors of out-of-hospital cardiac arrest: a systematic review. Resuscitation. 2009; 80:297-305.
MOULAERT VR, WACHELDER EM, VERBUNT JA, WADE DT, VAN HEUGTEN CM. Determinants of quality of life in survivors of cardiac arrest. J Rehabil Med. 2010; 42:553-8.
NICHOL G, STIELL IG, HEBERT P, WELLS GA, VANDEMHEEN K, LAUPACIS A. What is the quality of life for survivors of cardiac arrest? A prospective study. Acad Emerg Med. 1999; 6:95-102.
EDGREN E, KELSEY S, SUTTON K, SAFAR P. The preenting ECG pattern in survivors of cardiac arrest and its relation to the subsequent long-term survival. Acta Anaesthesiol Scand. 1989; 33:265-71.
HAMEL MB, PHILLIPS R, TENO J, DAVIS RB, GOLDMAN L, LYNN J, ET AL. Cost effectiveness of aggressive care for patients with nontraumatic coma. Crit Care Med. 2002; 30:1191-6.
BURKE DT, SHAH MK, DORVLO AS, ALADAWI S. Rehabilitation outcomes of cardiac and noncardiac anoxic brain injury: a single institution experience. Brain Inj. 2005; 19:675-80.
GEOCADIN RG, KOENIG MA, JIA X, STEVENS RD, PEBERDY MA. Management of brain injury after resuscitation from cardiac arrest. Neurol Clin. 2008; 26:487-506.
XIONG W, HOESCH RE, GEOCADIN RG. Postcardiac arrest encephalopathy. Semin Neurol. 2011; 31:216-25.
KARANJIA N, GEOCADIN RG. Post-cardiac arrest syndrome: update on brain injury management and prognostication. Curr Treat Options Neurol. 2011;13:191-203.
HOWARD RS, HOLMES PA, KOUTROUMANIDIS MA. Hypoxic-ischaemic brain injury. Practical neurology. 2011; 11:4-18.
NOLAN JP, NEUMAR RW, ADRIE C, AIBIKI M, BERG RA, BBTTIGER BW, ET AL. 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). Int Emerg Nurs. 2010; 18:8-28.
NOLAN JP, NEUMAR RW, ADRIE C, AIBIKI M, BERG RA, BBTTIGER BW, ET AL. 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 1). Int Emerg Nurs. 2009; 17:203-25.
STUB D, BERNARD S, DUFFY SJ, KAYE DM. Post cardiac arrest syndrome: a review of therapeutic strategies. Circulation. 2011; 123:1428-35.
LAVER S, FARROW C, TURNER D, NOLAN J. Mode of death after admission to an intensive care unit following cardiac arrest. Intensive Care Med. 2004; 30:2126-8.
BUSL KM, GREER DM. Hypoxic-ischemic brain injury: pathophysiology, neuropathology and mechanisms. NeuroRehabilitation. 2010; 26:5-13.
SHARMA HS, MICLESCU A, WIkLUND L. Cardiac arrest-induced regional blood-brain barrier breakdown, edema formation and brain pathology: a light and electron microscopic study on a new model for neurodegeneration and neuroprotection in por-cine brain. J Neural Transm. 2011; 118:87-114.
VAAGENES P, GINSBERG M, EBMEYER U, ERNSTER L, FISCHER M, GISVOLD SE, ET AL. Cerebral resuscitation from cardiac arrest: pathophysiologic mechanisms. Crit Care Med. 1996; 24:57-68.
LIPTOT SA. NMDA receptor activity regulates transcription of antioxidant pathways. Nat Neurosci. 2008; 11:381-2.
FERNÁNDEZ-GÓMEZ FJ, HERNÁNDEZ F, ARGANDOÑA L, GALINDO MF, SEGURA TT, JORDÁN. Pharmacology of neuroprotection in acute ischemic stroke. J Rev Neurol. 2008; 47:253-60.
Dolga AM, Terpolilli N, Kepura F, Nijholt IM, Knaus HG, D'Orsi B, et al. KCa2 channels activation prevents [Ca2+] i deregulation and reduces neuronal death following glutamate toxicity and cerebral ischemia. Cell Death Dis. 2011;2:e147.
ARUNDINE M, TYMIANSKI M. Molecular mechanisms of calcium-dependent neurodegeneration in excitotoxicity. Cell Calcium. 2003; 34:325-37.
LAU A, TYMIANSKI M. Glutamate receptors, neurotoxicity and neurodegeneration. Pflugers Arch. 2010; 460:525-42.
ONO T, TSURUTA R, FUJITA M, AKI HS, KUTSUNA S, KAWAMURA Y, ET AL. Xanthine oxidase is one of the major sources of superoxide anion radicals in blood after reperfusion in rats with forebrain ischemia/reperfusion. Brain Res. 2009; 1305:158-67.
CHEN H, YOSHIOKA H, KIM GS, JUNG JE, OKAMI N, SAKATA H. Oxidative stress in ischemic brain damage: mechanisms of cell death and potential molecular targets for neuroprotection. Antioxid Redox Signal. 2011; 14:1505-17.
GREER DM. Mechanisms of injury in hypoxicischemic encephalopathy: implications to therapy. Semin Neurol. 2006; 26:373-9.
HARUKUNI I, BHARDWAJ A. Mechanisms of brain injury after global cerebral ischemia. Neurol Clin. 2006; 24:1-21.
XU K, PUCHOWICZ MA, SUN X, LAMANNA JC. Decreased brainstem function following cardiac arrest and resuscitation in aged rat. Brain Res. 2010; 1328:181-9.
WIJDICKS EF, CAMPEAU NG, MILLER GM. MR imaging in comatose survivors of cardiac resuscitation. AJNR Am J Neuroradiol. 2001; 22:1561-5.
WIJDICKS EF. The diagnosis of brain death. N Engl J Med. 2001; 344:1215-21.
STERIADE M. Corticothalamic resonance, states of vigilance and mentation. Neuroscience. 2000; 101:243-76.
HOESCH RE, KOENIG MA, GEOCADIN RG. Coma after global ischemic brain injury: patho-physiology and emerging therapies. Crit Care Clin. 2008; 24:25-44.
LU-EMERSON C, KHOT S. Neurological sequelae of hypoxic-ischemic brain injury. NeuroRehabilitation. 2010; 26:35-45.
BUSSIÈRE M, YOUNG GB. Anoxic-Ischemic Encephalopathy and Strokes Causing Impaired Consciousness. Neurol Clin. 2011; 29:825-36.
ANDERSON CA, ARCINIEGAS DB. Cognitive sequelae of hypoxic-ischemic brain injury: a review. NeuroRehabilitation. 2010; 26:47-63.
SAUVE MJ, DOOLITTLE N, WALKER JA, PAUL SM, SCHEINMAN MM. Factors associated with cognitive recovery after cardiopulmonary resuscitation. Am J Crit Care. 1996; 5:127-39.
RAINA KD, CALLAWAY C, RITTENBERGER JC, HOLM MB. Neurological and functional status following cardiac arrest: method and tool utility. Resuscitation. 2008; 79:249-56.
VAN ALEM AP, DE VOS R, SCHMAND B, KOSTER RW. Cognitive impairments in survivors of out-of-hospital cardiac arrest. Am Heart J. 2004;148:416-21.
JENNETT B, BOND M. Assessment of outcome after severe brain damage. Lancet. 1975; 7905:480-4.
HSU JWY, MADSEN CD, CALLAHAM ML. Quality-of-life and formal functional testing of survivors of out-of-hospital cardiac arrest correlates poorly with traditional neurologic outcomes scales. Ann Emerg Med. 1996; 28:597-605.
StIELL IG, NESBITT LP, NICHOL G, MALONEY J, DREYER J, BEAUDOIN T, ET AL. OPALS Study Group. Comparison of the Cerebral Performance Category score and the Health Utilities Index for survivors of cardiac arrest. Ann Emerg Med. 2009; 53:241-8.
BERGE E, FJAERTOFT H, INDREDAVIK B, SANDSET PM. Validity and reliability of simple questions in assessing short- and long-term outcome in Norwegian stroke patients. Cerebrovasc Dis. 2001; 11:305-10.
MCKEVITT C, DUDNAS R, WOLFE C. Two simple questions to assess outcome after stroke: a European study. Stroke. 2001; 32:681-6.
LONGSTRETH WT JR, NICHOL G, VAN OTTINGHAM L, HALLSTROM AP. Two simple questions to assess neurologic outcomes at 3 months after out-of-hospital cardiac arrest: experience from the public access defibrillation trial. Resuscitation. 2010; 81:530-3.
LOGI F, FISCHER C, MURRI L, MAUGUIERE F. The prognostic value of evoked responses from primary somatosensory and auditory cortex in comatose patients. Clinical neurophysiology: official journal of the International Federation of Clinical Neurophysiology. 2003; 114:1615-27.
BOUWES A, BINNEKADE JM, ZANDSTRA DF, KOELMAN JH, VAN SCHAIK IN, HIJDRA A, ET AL. Somatosensory evoked potentials during mild hypothermia after cardiopulmonary resuscitation. Neurology. 2009; 73:1457-61.
YOUNG GB. Clinical practice. Neurologic prognosis after cardiac arrest. N Engl J Med. 2009; 361:605-11.
LEE YC, PHAN TG, JOLLEY DJ, CASTLEY HC, INGRAM DA, REUTENS DC. Accuracy of clinical signs, SEP, and EEG in predicting outcome of hypoxic coma: a meta-analysis. Neurology. 2010; 74:572-80.
DI BARI M, CHIARLONE M, FUMAGALLI S, BONCINELLI L, TARANTINI F, UNGAR A, ET AL. Cardiopulmonary resuscitation of older, inhospital patients: immediate efficacy and long-term outcome. Crit Care Med. 2000; 28:2320-5.
LUNDBYE JB, RAI M, RAMU B, HOSSEINIKHALILI A, LI D, SLIM HB, ET AL. Therapeutic hypothermia is associated with improved neurologic outcome and survival in cardiac arrest survivors of non-shockable rhythms. Resuscitation. 2012; 83:202-7.
SAKLAYEN M, LISS H, MARKERT R. In-hospital cardiopulmonary resuscitation. Survival in 1 hospital and literature review. Medicine (Baltimore). 1995; 74:163-75.
DE VOS R, KOSTER RW, DE HAAN RJ, OOST-ING H, VAN DER WOUW PA, LAMPE-SCHOEN-MAECKERS AJ. In-hospital cardiopulmonary resuscitation: prearrest morbidity and outcome. Archives of internal medicine. 1999; 159:845-50.
DUMOT JA, BURVAL DJ, SPRUNG J, WATERS JH, MRAOVIC B, KARAFA MT, ET AL. Outcome of adult cardiopulmonary resuscitations at a tertiary referral center including results of "limited" resuscitations. Archives of internal medicine. 2001; 161:1751-8.
HERLITZ J, BÅNGA, AUNE S, EKSTRÖM L, LUNDSTRÖM G, HOLMBERG S. Characteristics and outcome among patients suffering in-hospital cardiac arrest in monitored and non-monitored areas. Resuscitation. 2001; 48:125-35.
SAYRE MR, TRAVERS AH, DAYA M, GREENE HL, SALIVE ME, VIJAYARAGHAVAN K, ET AL. Measuring survival rates from sudden cardiac arrest: the elusive definition. Resuscitation. 2004; 62:25-34.
WIJDICKS EF, HIJDRA A, YOUNG GB, BASSETTI CL, WIEBE S. Practice parameter: prediction of outcome in comatose survivors after cardiopulmonary resuscitation (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology. 2006; 67:203-10.
RITTENBERGER JC, SANGL J, WHEELER M, GUYETTE FX, CALLAWAY CW. Association between clinical examination and outcome after cardiac arrest. Resuscitation. 2010; 81:1128-32.
ZHENG ZJ, CROFT JB, GILES WH, MENSAH GA. Sudden cardiac death in the United States, 1989 to 1998. Circulation. 2001; 104:2158-63.
ZANDBERGEN EG, HIJDRA A, KOELMAN JH, ET AL. PROPAC Study Group. Prediction of poor outcome within the first 3 days of postanoxic coma. Neurology. 2006; 66:62-8.
AL THENAYAN E, SAVARD M, SHARPE M, NORTON L, YOUNG B. Predictors of poor neurologic outcome after induced mild hypothermia following cardiac arrest. Neurology. 2008; 71:1535-7.
TACCONE FS, DONADELLO K, BEUMIER M, SCOLLETTA S. When, where and how to initiate hypothermia after adult cardiac arrest. Minerva Anestesiol. 2011; 77:927-33.
GEOCADIN RG, editors. Hypoxic-ischemic encephalopathy. Semin Neurol. 2006.
GINSBERG M, BELAYEV L. The effects of hypothermia and hyperthermia in global cerebral ischemia. In: Maier, C; Steinberg, G; editors. Hypothermia and cerebral ischemia. Totowa (NJ): Humana Press. 2004:17-38.
BUSTO R, GLOBUS MY, DIETRICH WD, ET AL. Effect of mild hypothermia on ischemia-induced release of neurotransmitters and free fatty acids in rat brain. Stroke. 1989; 20:904-10.
CARDELL M, BORIS-MOLLER F, WIELOCH T. Hypothermia prevents the ischemia-induced translocation and inhibition of protein kinase C in the rat striatum. J Neurochem. 1991; 57:1814-7.
DEMPSEY RJ, COMBS DJ, MALEY ME, ET AL. Moderate hypothermia reduces postischemic edema development and leukotriene production. Neurosurgery. 1987; 21:177-81.
KUMAR K, WU X, EVANS AT, ET AL. The effect of hypothermia on induction of heat shock protein (HSP]72 in ischemic brain. Metab Brain Dis. 1995; 10:283-91.
COLBOURNE F, GROOMS SY, ZUKIN RS, ET AL. Hypothermia rescues hippocampal CA1 neurons and attenuates down-regulation of the AMPAreceptor GluR2 subunit after fore-brain ischemia. Proc Natl Acad Sci USA. 2003; 100:2906-10.
CALLAWAY CW. Refining the use of therapeutic hypothermia after cardiac arrest. Crit Care Med. 2011; 39:201-2.
KERN KB, RAHMAN O. Emergent percutaneous coronary intervention for resuscitated victims of out-of-hospital cardiac arrest. Catheterization and cardiovascular interventions: official journal of the Society for Cardiac Angiography & Interventions. 2010; 75:616-24.
WOLFRUM S, PIERAU C, RADKE PW, SCHUNKERT H, KUROWSKI V. Mild therapeutic hypothermia in patients after out-of-hospital cardiac arrest due to acute ST-segment elevation myocardial infarction undergoing immediate percutaneous coronary intervention. Crit Care Med. 2008;36:1780-6.
MAGER A, KORNOWSKI R, MURNINKAS D, VAKNIN-ASSA H, UKABI S, BROSH D, ET AL. Out-come of emergency percutaneous coronary intervention for acute ST-elevation myocardial infarction complicated by cardiac arrest. Coronary artery disease. 2008; 19:615-8.
LETTIERI C, SAVONITTO S, DE SERVI S, GUAGLIUMI G, BELLI G, REPETTO A, ET AL. Emergency percutaneous coronary intervention in patients with ST-elevation myocardial infarction complicated by out-of-hospital cardiac arrest: early and mediumterm outcome. Am Heart J. 2009; 157:569-75.
GAROT P, LEFEVRE T, ELTCHANINOFF H, MORICE MC, TAMION F, ABRY B, ET AL. Sixmonth outcome of emergency percutaneous coronary intervention in resuscitated patients after cardiac arrest complicating ST-elevation myocardial infarction. Circulation. 2007; 115:1354-62.
GRASNER JT, MEYBOHM P, CALIEBE A, BOTTIGER BW, WNENT J, MESSELKEN M, ET AL. Postresuscitation care with mild therapeutic hypothermia and coronary intervention after out-of-hospital cardiopulmonary resuscitation: a prospective registry analysis. Critical Care. 2011;15:R61.
MOtTTILLO S, SHARMA K, EISENBERG MJ. Therapeutic hypothermia in acute myocardial infarction: a systematic review. The Canadian journal of cardiology. 2011; 27:555-61.
KURIHARA M, OGASAWARA S, KADOWAKI A, ONIZUKA S, SAMEJIMA M. [Consideration of early rehabilitation in the treatment of post-cardiac arrest syndrome]. Nihon rinsho Japanese journal of clinical medicine. 2011; 69:653-7.
DIMYAN MA, DOBKKIN BH, COHEN LG. Emerging subspecialties: neurorehabilitation: training neurologists to retrain the brain. Neurology. 2008; 70:e52-4.
FERTL E, VASS K, STERZ F, GABRIEL H, AUFF E. Neurological rehabilitation of severely disabled cardiac arrest survivors. Part I. Course of post-acute inpatient treatment. Resuscitation. 2000; 47:231-9.
PUSSWALD G, FERTL E, FALTL M, AUFF E. Neurological rehabilitation of severely disabled cardiac arrest survivors. Part II. Life situation of patients and families after treatment. Resuscitation. 2000; 47:241-8.
HOWELL K, GRILL E, KLEIN AM, STRAUBE A, BENDER A. Rehabilitation outcome of anoxicischaemic encephalopathy survivors with prolonged disorders of consciousness. Resuscitation. 2013; 84:1409-15.
OTTENBACHER KJ. The post-stroke rehabilitation outcomes project. Archives of physical medicine and rehabilitation. 2005; 86:S121-3.
STEULTJENS EM, DEKKER J, BOUTER LM, VAN DE NES JC, CUP EH, VAN DEN ENDE CH. Occupational therapy for stroke patients: a systematic review. Stroke. 2003; 34:676-87.
CHARD SE. Community neurorehabilitation: a synthesis of current evidence and future research directions. NeuroRx: the journal of the American Society for Experimental NeuroTherapeutics. 2006; 3:525-34.
LEÓN-SARMIENTO FE, BAYONA-PRIETO J, CADENA Y. Plasticidad neuronal, neurorehabilitación y trastornos del movimiento: el cambio es ahora. Acta Neurol Colomb. 2008; 24:40-2.
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.