Generic selectors
Exact matches only
Search in title
Search in content
Post Type Selectors
Search in posts
Search in pages
Filter by Categories
Brief Communication
Cardiac Critical Care, Case Report
Cardiac Critical Care, Case Series
Cardiac Critical Care, Editorial
Cardiac Critical Care, Invited Editorial
Cardiac Critical Care, Original Article
Cardiac Critical Care, Point of Technique
Cardiac Critical Care, Review Article
Case Report
Case Report, Cardiac Critical Care
Case Series, Cardiac Critical Care
Editorial
Editorial, Cardiac Critical Care
Invited Editorial, Cardiac Critical Care
JCCC Quiz, Cardiac Critical Care
Legends in Cardiac Sciences
Letter To Editor Response
Letter to Editor, Cardiac Anesthesia
Letter to Editor, Cardiac Critical Care
Letter to the Editor
Narrative Review, Cardiac Critical Care
Original Article
Original Article, Cardiac Critical Care
Original Article, Cardiology
Perspective Insights
Perspective, Cardiac Critical Care
Point of Technique
Point of Technique, Cardiac Critical Care
Point of View, Cardiac Critical Care
Review Article
Review Article, Cardiac Critical Care
Review Article, Cardiology
Review Article, Evidence Based Medicine
Review Article, Invited
Short Communication, Cardiac Critical Care
Surgical Technique
Surgical Technique, Cardiology
Systematic Review
Technical Note
Video Case Report
Video Commentary
Generic selectors
Exact matches only
Search in title
Search in content
Post Type Selectors
Search in posts
Search in pages
Filter by Categories
Brief Communication
Cardiac Critical Care, Case Report
Cardiac Critical Care, Case Series
Cardiac Critical Care, Editorial
Cardiac Critical Care, Invited Editorial
Cardiac Critical Care, Original Article
Cardiac Critical Care, Point of Technique
Cardiac Critical Care, Review Article
Case Report
Case Report, Cardiac Critical Care
Case Series, Cardiac Critical Care
Editorial
Editorial, Cardiac Critical Care
Invited Editorial, Cardiac Critical Care
JCCC Quiz, Cardiac Critical Care
Legends in Cardiac Sciences
Letter To Editor Response
Letter to Editor, Cardiac Anesthesia
Letter to Editor, Cardiac Critical Care
Letter to the Editor
Narrative Review, Cardiac Critical Care
Original Article
Original Article, Cardiac Critical Care
Original Article, Cardiology
Perspective Insights
Perspective, Cardiac Critical Care
Point of Technique
Point of Technique, Cardiac Critical Care
Point of View, Cardiac Critical Care
Review Article
Review Article, Cardiac Critical Care
Review Article, Cardiology
Review Article, Evidence Based Medicine
Review Article, Invited
Short Communication, Cardiac Critical Care
Surgical Technique
Surgical Technique, Cardiology
Systematic Review
Technical Note
Video Case Report
Video Commentary
Generic selectors
Exact matches only
Search in title
Search in content
Post Type Selectors
Search in posts
Search in pages
Filter by Categories
Brief Communication
Cardiac Critical Care, Case Report
Cardiac Critical Care, Case Series
Cardiac Critical Care, Editorial
Cardiac Critical Care, Invited Editorial
Cardiac Critical Care, Original Article
Cardiac Critical Care, Point of Technique
Cardiac Critical Care, Review Article
Case Report
Case Report, Cardiac Critical Care
Case Series, Cardiac Critical Care
Editorial
Editorial, Cardiac Critical Care
Invited Editorial, Cardiac Critical Care
JCCC Quiz, Cardiac Critical Care
Legends in Cardiac Sciences
Letter To Editor Response
Letter to Editor, Cardiac Anesthesia
Letter to Editor, Cardiac Critical Care
Letter to the Editor
Narrative Review, Cardiac Critical Care
Original Article
Original Article, Cardiac Critical Care
Original Article, Cardiology
Perspective Insights
Perspective, Cardiac Critical Care
Point of Technique
Point of Technique, Cardiac Critical Care
Point of View, Cardiac Critical Care
Review Article
Review Article, Cardiac Critical Care
Review Article, Cardiology
Review Article, Evidence Based Medicine
Review Article, Invited
Short Communication, Cardiac Critical Care
Surgical Technique
Surgical Technique, Cardiology
Systematic Review
Technical Note
Video Case Report
Video Commentary
View/Download PDF

Translate this page into:

Letter to the Editor
4 (
2
); 163-164
doi:
10.1055/s-0040-1718984

Is It Necessary to Apply Neuroprotective Methods after Cardiac Arrest?

Department of Clinical Neurophysiology, Institute of Neurology and Neurosurgery, Havana, Cuba
Faculty of Social Welfare and Health Sciences, University of Haifa, Israel
Department of Neurology, University of the Medical Sciences, Havana, Cuba
Address for correspondence Gerry Leisman, MD, PhD Faculty of Social Welfare and Health Sciences, University of Haifa Abba Khoushy Ave. 199, Eshkol Tower, Rm. 910, Mt. Carmel, Haifa 3498838 Israel g.leisman@edu.haifa.ac.il
Licence
This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)
Disclaimer:
This article was originally published by Thieme Medical and Scientific Publishers Pvt. Ltd. and was migrated to Scientific Scholar after the change of Publisher.

To the Editor,

Cour et al1, 2 have analyzed risk factors in patients effectively resuscitated out-of-hospital cardiac arrest (OHCA) who progress to brain death (BD). Their study found that in those cases, resuscitated OHCA with predominantly nonshockable initial rhythms was independently associated with the following five simple risk factors associated with progression toward BD: female gender, young age, neurologic cause of cardiac arrest, duration of low-flow period, and persistent hemodynamic shock. These were independently associated with BD. The authors concluded that these factors might assist in the early recognition of a probable pool of future organ donors.3 Nonetheless, we require employment of neuroprotection methods to those cases suffering from OHCA or even from intrahospital cardiac arrests.3

Hypothermia is the best-known method to protect the brain and bodily organs against the effects ischemia and anoxia.4 The advantage of hypothermia treatment has also been supported by reports of patients suffering from accidental hypothermia (e.g., immersion/submersion in cold water, snow avalanche, or prolonged exposure to cold surroundings) combined with circulatory arrest or severe circulatory failure during long periods of time. When these patients were rewarmed to normothermia by use of extracorporeal circulation, good outcome in several cases has been reported.5, 6 The key point in these cases is that the neuroprotective effect occurred early, before a complete cardiac arrest had occurred.

Our commentary concerns the effects of hypoxia and ischemia on the brain after cardiac arrest. The human brain uses approximately 20% of the cardiac cycle, allowing cerebral blood flow (CBF) to be tightly regulated to meet the brain’s metabolic demands. The CBF dropping to less than 20 mL/100 gm/minute produces ischemic neuronal activity reduction but still reversible neuronal changes. CBF values less than 10mL/100 gm/minute result in irreversible ischemic neuronal damage within minutes, as reflected by membrane failure.7 That’s why the CBF values between 10 and 20 mL/100 gm/minute are considered the ischemic penumbra, reflecting neuronal tissue that may potentially be rescued.3, 7, 8

Even when resuscitation in cardiac arrest is successful, recovery is too often limited by anoxic encephalopathy. This complication increases with delay in resuscitation, and then the prognosis for comatose survivors of cardiac arrest is frequently poor.3

Several research groups have developed protocols for lowering body temperature in comatose survivors of cardiac arrest, resulting in a significant improvement in neurologic outcome. Safar8 documented in dog experimental models of prolonged exsanguination brain and organ preservation during cardiac arrest (no-flow) durations for up to 120 minutes. They noted that it is logical for mild hypothermia to be used in focal ischemic insults such as stroke, where it could play a neuroprotective role, but noted that reperfusion was critical in that condition, and hypothermia should serve as a bridge and/or adjunct in that regard. They stated that the plumbing must be addressed in stroke, otherwise acute therapies cannot be effective.9

Risk factors aiding clinicians in the prognosis of patients after OHCA are quite simple to determine.1 It is necessary to develop and apply neuroprotective methods to prevent brain damage due to anoxia and ischemia, initiated as soon as possible after cardiac arrest and maintained even during cardiopulmonary resuscitation.3

Conflict of Interest

None declared.

Author Contribution

Calixto Machado contributed to the conceptualization, writing, and original draft preparation, and Gerry Leisman contributed to the conceptualization, writing, and original draft preparation, reviewing, and editing.

References

  1. , , , , . Risk factors for progression toward brain death after out-of-hospital cardiac arrest. Ann Intensive Care. 2019;9(1):45.
    [Google Scholar]
  2. , , , , , . Long-term prognosis following resuscitation from out of hospital cardiac arrest: role of percutaneous coronary intervention and therapeutic hypothermia. J Am Coll Cardiol. 2012;60(1):21-27.
    [Google Scholar]
  3. , . The brain is the target organ in cardiorespiratory reanimation. Curr Anaesth Crit Care. 2009;20:148.
    [Google Scholar]
  4. , , , . No cold death-extracorporeal life support for all victims of accidental hypothermia. J Cardiothorac Vasc Anesth. 2020;34(2):372-373.
    [Google Scholar]
  5. , , , et al . Outcome of accidental hypothermia with or without circulatory arrest: experience from the Danish Præstø Fjord boating accident. Resuscitation. 2012;83(9):1078-1084.
    [Google Scholar]
  6. , , , . Post-cardiac arrest care in the neonatal intensive care unit. Resuscitation. 2020;150:102-103.
    [Google Scholar]
  7. , . Neurophysiologic monitoring in the neuroscience intensive care unit. Neurol Clin. 1995;13(3):579-626.
    [Google Scholar]
  8. , . Mild hypothermia in resuscitation: a historical perspective. Ann Emerg Med. 2003;41(6):887-888, author reply 888.
    [Google Scholar]
  9. , , , . Therapeutic hypothermia: the Safar vision. J Neurotrauma. 2009;26(3):417-420.
    [Google Scholar]

Fulltext Views
217

PDF downloads
226
View/Download PDF
Download Citations
BibTeX
RIS
Show Sections