Cerebral monitoring in a pig model of cardiac arrest with 48 h of intensive care.
Acute myocardial infarction
Heart arrest
Post-cardiac arrest intensive care
Targeted temperature management
Journal
Intensive care medicine experimental
ISSN: 2197-425X
Titre abrégé: Intensive Care Med Exp
Pays: Germany
ID NLM: 101645149
Informations de publication
Date de publication:
26 Oct 2022
26 Oct 2022
Historique:
received:
03
08
2022
accepted:
17
10
2022
entrez:
25
10
2022
pubmed:
26
10
2022
medline:
26
10
2022
Statut:
epublish
Résumé
Neurological injury is the primary cause of death after out-of-hospital cardiac arrest. There is a lack of studies investigating cerebral injury beyond the immediate post-resuscitation phase in a controlled cardiac arrest experimental setting. The aim of this study was to investigate temporal changes in measures of cerebral injury and metabolism in a cardiac arrest pig model with clinically relevant post-cardiac arrest intensive care. A cardiac arrest group (n = 11) underwent 7 min of no-flow and was compared with a sham group (n = 6). Pigs underwent intensive care with 24 h of hypothermia at 33 °C. Blood markers of cerebral injury, cerebral microdialysis, and intracranial pressure (ICP) were measured. After 48 h, pigs underwent a cerebral MRI scan. Data are presented as median [25th; 75th percentiles]. Return of spontaneous circulation was achieved in 7/11 pigs. Time to ROSC was 4.4 min [4.2; 10.9]. Both NSE and NfL increased over time (p < 0.001), and were higher in the cardiac arrest group at 48 h (NSE 4.2 µg/L [2.4; 6.1] vs 0.9 [0.7; 0.9], p < 0.001; NfL 63 ng/L [35; 232] vs 29 [21; 34], p = 0.02). There was no difference in ICP at 48 h (17 mmHg [14; 24] vs 18 [13; 20], p = 0.44). The cerebral lactate/pyruvate ratio had secondary surges in 3/7 cardiac arrest pigs after successful resuscitation. Apparent diffusion coefficient was lower in the cardiac arrest group in white matter cortex (689 × 10 We have developed a clinically relevant cardiac arrest pig model that displays cerebral injury as marked by NSE and NfL elevations, signs of cerebral oedema, and reduced neuron viability. Overall, the burden of elevated ICP was low in the cardiac arrest group. A subset of pigs undergoing cardiac arrest had persisting metabolic disturbances after successful resuscitation.
Sections du résumé
BACKGROUND
BACKGROUND
Neurological injury is the primary cause of death after out-of-hospital cardiac arrest. There is a lack of studies investigating cerebral injury beyond the immediate post-resuscitation phase in a controlled cardiac arrest experimental setting.
METHODS
METHODS
The aim of this study was to investigate temporal changes in measures of cerebral injury and metabolism in a cardiac arrest pig model with clinically relevant post-cardiac arrest intensive care. A cardiac arrest group (n = 11) underwent 7 min of no-flow and was compared with a sham group (n = 6). Pigs underwent intensive care with 24 h of hypothermia at 33 °C. Blood markers of cerebral injury, cerebral microdialysis, and intracranial pressure (ICP) were measured. After 48 h, pigs underwent a cerebral MRI scan. Data are presented as median [25th; 75th percentiles].
RESULTS
RESULTS
Return of spontaneous circulation was achieved in 7/11 pigs. Time to ROSC was 4.4 min [4.2; 10.9]. Both NSE and NfL increased over time (p < 0.001), and were higher in the cardiac arrest group at 48 h (NSE 4.2 µg/L [2.4; 6.1] vs 0.9 [0.7; 0.9], p < 0.001; NfL 63 ng/L [35; 232] vs 29 [21; 34], p = 0.02). There was no difference in ICP at 48 h (17 mmHg [14; 24] vs 18 [13; 20], p = 0.44). The cerebral lactate/pyruvate ratio had secondary surges in 3/7 cardiac arrest pigs after successful resuscitation. Apparent diffusion coefficient was lower in the cardiac arrest group in white matter cortex (689 × 10
CONCLUSIONS
CONCLUSIONS
We have developed a clinically relevant cardiac arrest pig model that displays cerebral injury as marked by NSE and NfL elevations, signs of cerebral oedema, and reduced neuron viability. Overall, the burden of elevated ICP was low in the cardiac arrest group. A subset of pigs undergoing cardiac arrest had persisting metabolic disturbances after successful resuscitation.
Identifiants
pubmed: 36284020
doi: 10.1186/s40635-022-00475-2
pii: 10.1186/s40635-022-00475-2
pmc: PMC9596181
doi:
Types de publication
Journal Article
Langues
eng
Pagination
45Informations de copyright
© 2022. The Author(s).
Références
BMC Anesthesiol. 2020 Sep 29;20(1):252
pubmed: 32993500
Am J Emerg Med. 2017 Nov;35(11):1645-1652
pubmed: 28521971
Intensive Care Med. 1991;17(7):392-8
pubmed: 1774392
PLoS One. 2021 Feb 4;16(2):e0245931
pubmed: 33539360
Resuscitation. 2021 Jul;164:114-121
pubmed: 33930501
JAMA Neurol. 2019 Jan 1;76(1):64-71
pubmed: 30383090
Resuscitation. 2017 Jan;110:26-31
pubmed: 27984152
J Biomed Inform. 2019 Jul;95:103208
pubmed: 31078660
Acta Anaesthesiol Scand. 2010 Apr;54(4):494-501
pubmed: 19912127
Crit Care. 2021 Jan 20;25(1):32
pubmed: 33472689
Ther Hypothermia Temp Manag. 2016 Dec;6(4):189-193
pubmed: 27213805
Intensive Care Med. 1987;13(4):256-9
pubmed: 3611496
Circulation. 1996 Nov 1;94(9):2324-36
pubmed: 8901707
J Am Heart Assoc. 2021 Dec 7;10(23):e022679
pubmed: 34854307
Heliyon. 2019 Mar 19;5(3):e01363
pubmed: 30949607
Resuscitation. 2019 Mar;136:93-99
pubmed: 30710595
Analyst. 2020 Mar 7;145(5):1894-1902
pubmed: 31984382
Resuscitation. 2003 Nov;59(2):255-60
pubmed: 14625117
Resuscitation. 2017 Apr;113:115-123
pubmed: 28214538
Resuscitation. 2006 Oct;71(1):97-106
pubmed: 16942830
Intensive Care Med. 2020 Oct;46(10):1803-1851
pubmed: 32915254
Crit Care. 2018 Jun 5;22(1):150
pubmed: 29871657
Resuscitation. 2019 Aug;141:96-103
pubmed: 31185256
Eur J Anaesthesiol. 2006 Jun;23(6):501-9
pubmed: 16507191
Resuscitation. 2020 Nov;156:223-229
pubmed: 32652117
Resuscitation. 2021 Oct;167:251-260
pubmed: 34166747
Resuscitation. 2006 Jun;69(3):487-94
pubmed: 16678959
Intensive Care Med. 2021 Jan;47(1):39-48
pubmed: 32852582
Resuscitation. 2021 Apr;161:220-269
pubmed: 33773827
Resuscitation. 2018 Aug;129:121-126
pubmed: 29679696
Circ Res. 2021 Aug 20;129(5):583-597
pubmed: 34287000
J Physiol. 2020 Sep;598(18):3793-3801
pubmed: 32666574
Ther Hypothermia Temp Manag. 2019 Jun;9(2):136-145
pubmed: 30239278
Neurology. 2020 Apr 21;94(16):e1684-e1692
pubmed: 32269116
Neuroradiology. 2017 Jun;59(6):545-553
pubmed: 28540400