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New Therapies for Post-cardiac Arrest Syndrome
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New Therapies for Post-cardiac Arrest Syndrome

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Cardiology".

Deadline for manuscript submissions: closed (20 October 2022) | Viewed by 8608

Special Issue Editor

Dr. Kei Hayashida

E-Mail Website
Guest Editor
1. Laboratory for Critical Care Physiology, Feinstein Institutes for Medical Research, Northwell Health System, Manhasset, NY 11030, USA
2. Department of Emergency Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY 11549, USA
Interests: cardiopulmonary resuscitation; prehospital medicine; CPR; mechanical ventilation; ischemia reperfusion injury; shock; inflammation; emergency medicine; critical care medicine; anesthesiology
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Despite advances in cardiopulmonary resuscitation methods, neurological prognosis remains poor among survivors of out-of-hospital cardiac arrest. Limited progress has been made in improving outcomes after cardiac arrest. We lack established pharmaceutical interventions or reliable methods for predicting neurological outcomes after cardiac arrest. All clinical and biological manifestations related to post-cardiac arrest syndrome are attributed to whole-body ischemia, followed by reperfusion in multiple organs. It has been shown that several different processes can ultimately lead to cell death in the pathology of post-cardiac arrest syndrome, including vasoconstriction, protein modification, impaired mitochondrial respiration, cell death signaling, inflammation, and excessive oxidative stress. This Special Issue aims to report an overview of the latest research on novel therapies and diagnostic techniques for post-cardiac arrest syndrome. Authors are invited to submit original research articles and review papers about the recent advances in therapies and diagnostic approaches that could assist clinicians in clinical practice.

Dr. Kei Hayashida
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • cardiac arrest
  • post-cardiac arrest syndrome
  • cardiopulmonary resuscitation
  • post-cardiac arrest care
  • ischemia reperfusion injury
  • shock
  • anti-oxidant
  • anti-inflammation
  • mitochondria
  • neurological outcome
  • prognostication

Published Papers (3 papers)

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Research

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16 pages, 3866 KiB  
Article
Real-Time Brain Monitoring by Near-Infrared Spectroscopy Predicts Neurological Outcome after Cardiac Arrest and Resuscitation in Rats: A Proof of Concept Study of a Novel Prognostic Measure after Cardiac Arrest
by Ryosuke Takegawa, Kei Hayashida, Tai Yin, Rishabh C. Choudhary, Santiago J. Miyara, Houman Khalili, Muhammad Shoaib, Yusuke Endo, Emesto P. Molmenti and Lance B. Becker
J. Clin. Med. 2022, 11(1), 131; https://doi.org/10.3390/jcm11010131 - 27 Dec 2021
Cited by 2 | Viewed by 3045
Abstract
Clinical studies have demonstrated that dynamic changes in regional cerebral oxygen saturation (rSO2) after cardiac arrest (CA) and cardiopulmonary resuscitation (CPR) have a role in predicting neurological outcomes after the return of spontaneous circulation (ROSC). Our study evaluated whether the timing [...] Read more.
Clinical studies have demonstrated that dynamic changes in regional cerebral oxygen saturation (rSO2) after cardiac arrest (CA) and cardiopulmonary resuscitation (CPR) have a role in predicting neurological outcomes after the return of spontaneous circulation (ROSC). Our study evaluated whether the timing of rSO2 decline shortly after CPR reflects the severity of brain injury in a rat model of CA. Rats were subjected to different durations of asphyxia to produce variable severities of brain injury, due to CA. Time from ROSC to achieving the initial minimum rSO2 was defined as Tnadir. A Tnadir cut-off of 24 min had optimal sensitivity and specificity for predicting good neurological outcomes at 72 h after ROSC (AUC, 0.88; sensitivity, 89%; specificity, 86%; p < 0.01). Immunohistochemistry at 72 h post-CA revealed that the number of Fluoro-Jade B positive degenerating neurons in the hippocampus CA1 sector were markedly higher in animals with Tnadir > 24 min than that in animals with Tnadir ≤ 24 min. There was no difference in the gene expressions of cytokines and mitochondrial fission proteins in the brain at 2 h after ROSC between rats with Tnadir > 24 min and with Tnadir ≤ 24 min. In conclusion, Tnadir can be a novel predictor of good neurological outcomes after CA/CPR. Full article
(This article belongs to the Special Issue New Therapies for Post-cardiac Arrest Syndrome)
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12 pages, 1206 KiB  
Article
Different Stratification of Physiological Factors Affecting Cerebral Perfusion Pressure in Hypoxic-Ischemic Brain Injury after Cardiac Arrest According to Visible or Non-Visible Primary Brain Injury: A Retrospective Observational Study
by Changshin Kang, Wonjoon Jeong, Jung Soo Park, Yeonho You, Jin Hong Min, Yong Chul Cho, Hong Joon Ahn, Yong Nam In and In Ho Lee
J. Clin. Med. 2021, 10(22), 5385; https://doi.org/10.3390/jcm10225385 - 18 Nov 2021
Cited by 2 | Viewed by 1830
Abstract
We aimed to explore the stratification of physiological factors affecting cerebral perfusion pressure, including arterial oxygen tension, arterial carbon dioxide tension, mean arterial pressure, intracranial pressure (ICP), and blood-brain barrier (BBB) status, with respect to primary or secondary brain injury (PBI or SBI) [...] Read more.
We aimed to explore the stratification of physiological factors affecting cerebral perfusion pressure, including arterial oxygen tension, arterial carbon dioxide tension, mean arterial pressure, intracranial pressure (ICP), and blood-brain barrier (BBB) status, with respect to primary or secondary brain injury (PBI or SBI) after out-of-hospital cardiac arrest (OHCA). Among the retrospectively enrolled 97 comatose OHCA survivors undergoing post-cardiac arrest (PCA) care, 46 (47.4%) with already established PBI (high signal intensity (HSI) on diffusion-weighted imaging (DWI) had higher ICP (p = 0.02) and poorer BBB status (p < 0.01) than the non-HSI group. On subgroup analysis within the non-HSI group to exclude the confounding effect of already established PBI, 40 (78.4%) patients with good neurological outcomes had lower ICP at 24 h (11.0 vs. 16.0 mmHg, p < 0.01) and more stable BBB status (p = 0.17 in pairwise comparison) compared to those with poor neurological outcomes, despite the non-significant differences in other physiological factors. OHCA survivors with HSI on DWI showed significantly higher ICP and poorer BBB status at baseline before PCA care than those without HSI. Despite the negative DWI findings before PCA care, OHCA survivors have a cerebral penumbra at risk for potentially leading the poor neurological outcome from unsuppressed SBI, which may be associated with increased ICP and BBB permeability. Full article
(This article belongs to the Special Issue New Therapies for Post-cardiac Arrest Syndrome)
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Review

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8 pages, 1036 KiB  
Review
Differential Effectiveness of Hypothermic Targeted Temperature Management According to the Severity of Post-Cardiac Arrest Syndrome
by Kazuya Kikutani, Mitsuaki Nishikimi, Tatsutoshi Shimatani, Michihito Kyo, Shinichiro Ohshimo and Nobuaki Shime
J. Clin. Med. 2021, 10(23), 5643; https://doi.org/10.3390/jcm10235643 - 30 Nov 2021
Cited by 5 | Viewed by 2723
Abstract
International guidelines recommend targeted temperature management (TTM) to improve the neurological outcomes in adult patients with post-cardiac arrest syndrome (PCAS). However, it still remains unclear if the lower temperature setting (hypothermic TTM) or higher temperature setting (normothermic TTM) is superior for TTM. According [...] Read more.
International guidelines recommend targeted temperature management (TTM) to improve the neurological outcomes in adult patients with post-cardiac arrest syndrome (PCAS). However, it still remains unclear if the lower temperature setting (hypothermic TTM) or higher temperature setting (normothermic TTM) is superior for TTM. According to the most recent large randomized controlled trial (RCT), hypothermic TTM was not found to be associated with superior neurological outcomes than normothermic TTM in PCAS patients. Even though this represents high-quality evidence obtained from a well-designed large RCT, we believe that we still need to continue investigating the potential benefits of hypothermic TTM. In fact, several studies have indicated that the beneficial effect of hypothermic TTM differs according to the severity of PCAS, suggesting that there may be a subgroup of PCAS patients that is especially likely to benefit from hypothermic TTM. Herein, we summarize the results of major RCTs conducted to evaluate the beneficial effects of hypothermic TTM, review the recent literature suggesting the possibility that the therapeutic effect of hypothermic TTM differs according to the severity of PCAS, and discuss the potential of individualized TTM. Full article
(This article belongs to the Special Issue New Therapies for Post-cardiac Arrest Syndrome)
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