Bedside microdialysis for detection of early brain injury after out-of-hospital cardiac arrest.
Adult
Aged
Biomarkers
/ blood
Brain
/ metabolism
Brain Injuries
/ blood
Brain Ischemia
/ blood
Cerebral Veins
/ metabolism
Energy Metabolism
Feasibility Studies
Female
Humans
Lactic Acid
/ analysis
Male
Microdialysis
/ methods
Middle Aged
Out-of-Hospital Cardiac Arrest
/ blood
Oxygen
/ metabolism
Prospective Studies
Pyruvic Acid
/ analysis
Journal
Scientific reports
ISSN: 2045-2322
Titre abrégé: Sci Rep
Pays: England
ID NLM: 101563288
Informations de publication
Date de publication:
05 08 2021
05 08 2021
Historique:
received:
05
03
2021
accepted:
26
07
2021
entrez:
6
8
2021
pubmed:
7
8
2021
medline:
9
11
2021
Statut:
epublish
Résumé
Bedside detection and early treatment of lasting cerebral ischemia may improve outcome after out-of-hospital cardiac arrest (OHCA). This feasibility study explores the possibilities to use microdialysis (MD) for continuous monitoring of cerebral energy metabolism by analyzing the draining cerebral venous blood. Eighteen comatose patients were continuously monitored with jugular bulb and radial artery (reference) MD following resuscitation. Median time from cardiac arrest to MD was 300 min (IQR 230-390) with median monitoring time 60 h (IQR 40-81). The lactate/pyruvate ratio in cerebral venous blood was increased during the first 20 h after OHCA, and significant differences in time-averaged mean MD metabolites between jugular venous and artery measurements, were documented (p < 0.02). In patients with unfavorable outcome (72%), cerebral venous lactate and pyruvate levels remained elevated during the study period. In conclusion, the study indicates that jugular bulb microdialysis (JBM) is feasible and safe. Biochemical signs of lasting ischemia and mitochondrial dysfunction are frequent and associated with unfavorable outcome. The technique may be used in comatose OHCA patients to monitor biochemical variables reflecting ongoing brain damage and support individualized treatment early after resuscitation.
Identifiants
pubmed: 34354178
doi: 10.1038/s41598-021-95405-9
pii: 10.1038/s41598-021-95405-9
pmc: PMC8342553
doi:
Substances chimiques
Biomarkers
0
Lactic Acid
33X04XA5AT
Pyruvic Acid
8558G7RUTR
Oxygen
S88TT14065
Types de publication
Clinical Trial
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
15871Informations de copyright
© 2021. The Author(s).
Références
Intensive Care Med Exp. 2019 Dec 4;7(1):67
pubmed: 31802303
Intensive Care Med. 2021 Apr;47(4):369-421
pubmed: 33765189
Crit Care. 2017 Apr 13;21(1):96
pubmed: 28410590
Resuscitation. 2020 Sep;154:85-92
pubmed: 32544414
Brain Res. 2010 Apr 30;1328:181-9
pubmed: 20211610
J Neurol Neurosurg Psychiatry. 1998 Apr;64(4):486-91
pubmed: 9576540
Crit Care. 2017 Apr 13;21(1):90
pubmed: 28403909
Nat Rev Neurosci. 2002 Sep;3(9):748-55
pubmed: 12209123
Neurology. 2016 Apr 19;86(16):1482-90
pubmed: 26865516
Acta Anaesthesiol Scand. 2013 Jul;57(6):793-801
pubmed: 23495747
Intensive Care Med. 2015 Sep;41(9):1517-28
pubmed: 26194024
Crit Care Med. 2020 Mar;48(3):378-384
pubmed: 31789834
N Engl J Med. 2013 Dec 5;369(23):2197-206
pubmed: 24237006
Front Neurol. 2017 Jun 19;8:274
pubmed: 28674514
Front Pediatr. 2017 Aug 16;5:174
pubmed: 28861407
Neurocrit Care. 2021 Feb;34(1):64-72
pubmed: 32358767
J Cardiothorac Vasc Anesth. 2017 Aug;31(4):1166-1173
pubmed: 28089142
Circulation. 2015 Sep 29;132(13):1286-300
pubmed: 25391522
J Am Heart Assoc. 2015 Sep 14;4(9):e002232
pubmed: 26370446
J Cereb Blood Flow Metab. 1985 Sep;5(3):439-45
pubmed: 4030921
Resuscitation. 2014 Aug;85(8):1037-41
pubmed: 24795284
Acta Anaesthesiol Scand. 2009 Mar;53(3):289-98
pubmed: 19243314
Intensive Care Med. 2004 Jan;30(1):159-61
pubmed: 14586493
J Matern Fetal Neonatal Med. 2010 Feb;23(2):158-66
pubmed: 20074023
Resuscitation. 2020 Mar 1;148:218-226
pubmed: 32027980
J Clin Endocrinol Metab. 1993 Feb;76(2):392-8
pubmed: 8381801
Intensive Care Med Exp. 2016 Dec;4(1):3
pubmed: 26791144
Crit Care. 2019 May 14;23(1):171
pubmed: 31088512
Resuscitation. 2017 Jan;110:26-31
pubmed: 27984152
Stroke. 1979 Jul-Aug;10(4):437-46
pubmed: 505482
Resuscitation. 2017 May;114:79-82
pubmed: 28279695
Brain Res. 1975 Mar 14;86(1):31-44
pubmed: 234773
Neurosurgery. 2000 Sep;47(3):701-9; discussion 709-10
pubmed: 10981758
Crit Care Med. 2019 Jul;47(7):960-969
pubmed: 30889022
Intensive Care Med. 2018 Jun;44(6):966-967
pubmed: 29379993
J Neurotrauma. 2014 Sep 1;31(17):1528
pubmed: 24417687
J Neurochem. 1978 Feb;30(2):479-86
pubmed: 624953
NeuroRehabilitation. 2010;26(1):5-13
pubmed: 20130351
Neurocrit Care. 2020 Aug;33(1):241-255
pubmed: 31845174
Brain Res. 1974 Jun 20;73(2):277-89
pubmed: 4831083
Resuscitation. 2016 Mar;100:6-10
pubmed: 26744101