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Beekman R, Khosla A, Buckley R, Honiden S, Gilmore EJ. Temperature Control in the Era of Personalized Medicine: Knowledge Gaps, Research Priorities, and Future Directions. J Intensive Care Med 2024; 39:611-622. [PMID: 37787185 DOI: 10.1177/08850666231203596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
Hypoxic-ischemic brain injury (HIBI) is the leading cause of death and disability after cardiac arrest. To date, temperature control is the only intervention shown to improve neurologic outcomes in patients with HIBI. Despite robust preclinical evidence supporting hypothermia as neuroprotective therapy after cardiac arrest, there remains clinical equipoise regarding optimal core temperature, therapeutic window, and duration of therapy. Current guidelines recommend continuous temperature monitoring and active fever prevention for at least 72 h and additionally note insufficient evidence regarding temperature control targeting 32 °C-36 °C. However, population-based thresholds may be inadequate to support the metabolic demands of ischemic, reperfused, and dysregulated tissue. Promoting a more personalized approach with individualized targets has the potential to further improve outcomes. This review will analyze current knowledge and evidence, address research priorities, explore the components of high-quality temperature control, and define critical future steps that are needed to advance patient-centered care for cardiac arrest survivors.
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Affiliation(s)
- Rachel Beekman
- Department of Neurology, Yale University School of Medicine, New Haven, CT, USA
| | - Akhil Khosla
- Department of Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Ryan Buckley
- Department of Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Shyoko Honiden
- Department of Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Emily J Gilmore
- Department of Neurology, Yale University School of Medicine, New Haven, CT, USA
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Dey P, Rajalaxmi S, Saha P, Thakur PS, Hashmi MA, Lal H, Saini N, Singh N, Ramanathan A. Cold-shock proteome of myoblasts reveals role of RBM3 in promotion of mitochondrial metabolism and myoblast differentiation. Commun Biol 2024; 7:515. [PMID: 38688991 PMCID: PMC11061143 DOI: 10.1038/s42003-024-06196-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 04/15/2024] [Indexed: 05/02/2024] Open
Abstract
Adaptation to hypothermia is important for skeletal muscle cells under physiological stress and is used for therapeutic hypothermia (mild hypothermia at 32 °C). We show that hypothermic preconditioning at 32 °C for 72 hours improves the differentiation of skeletal muscle myoblasts using both C2C12 and primary myoblasts isolated from 3 month and 18-month-old mice. We analyzed the cold-shock proteome of myoblasts exposed to hypothermia (32 °C for 6 and 48 h) and identified significant changes in pathways related to RNA processing and central carbon, fatty acid, and redox metabolism. The analysis revealed that levels of the cold-shock protein RBM3, an RNA-binding protein, increases with both acute and chronic exposure to hypothermic stress, and is necessary for the enhanced differentiation and maintenance of mitochondrial metabolism. We also show that overexpression of RBM3 at 37 °C is sufficient to promote mitochondrial metabolism, cellular proliferation, and differentiation of C2C12 and primary myoblasts. Proteomic analysis of C2C12 myoblasts overexpressing RBM3 show significant enrichment of pathways involved in fatty acid metabolism, RNA metabolism and the electron transport chain. Overall, we show that the cold-shock protein RBM3 is a critical factor that can be used for controlling the metabolic network of myoblasts.
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Affiliation(s)
- Paulami Dey
- Institute for Stem Cell Science and Regenerative Medicine (inStem), GKVK-Post, Bellary Rd, Bengaluru, 560065, Karnataka, India
- SASTRA Deemed University, Tirumalaisamudram, Thanjavur, 613401, Tamil Nadu, India
| | - Srujanika Rajalaxmi
- Institute for Stem Cell Science and Regenerative Medicine (inStem), GKVK-Post, Bellary Rd, Bengaluru, 560065, Karnataka, India
| | - Pushpita Saha
- Institute for Stem Cell Science and Regenerative Medicine (inStem), GKVK-Post, Bellary Rd, Bengaluru, 560065, Karnataka, India
| | - Purvi Singh Thakur
- Institute for Stem Cell Science and Regenerative Medicine (inStem), GKVK-Post, Bellary Rd, Bengaluru, 560065, Karnataka, India
| | - Maroof Athar Hashmi
- Institute for Stem Cell Science and Regenerative Medicine (inStem), GKVK-Post, Bellary Rd, Bengaluru, 560065, Karnataka, India
- Manipal Academy of Higher Education, Manipal, 576104, Karnataka, India
| | - Heera Lal
- Institute for Stem Cell Science and Regenerative Medicine (inStem), GKVK-Post, Bellary Rd, Bengaluru, 560065, Karnataka, India
- Manipal Academy of Higher Education, Manipal, 576104, Karnataka, India
| | - Nistha Saini
- Institute for Stem Cell Science and Regenerative Medicine (inStem), GKVK-Post, Bellary Rd, Bengaluru, 560065, Karnataka, India
| | - Nirpendra Singh
- Institute for Stem Cell Science and Regenerative Medicine (inStem), GKVK-Post, Bellary Rd, Bengaluru, 560065, Karnataka, India
| | - Arvind Ramanathan
- Institute for Stem Cell Science and Regenerative Medicine (inStem), GKVK-Post, Bellary Rd, Bengaluru, 560065, Karnataka, India.
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Zhang H, Hu H, Zhai C, Jing L, Tian H. Cardioprotective Strategies After Ischemia-Reperfusion Injury. Am J Cardiovasc Drugs 2024; 24:5-18. [PMID: 37815758 PMCID: PMC10806044 DOI: 10.1007/s40256-023-00614-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/28/2023] [Indexed: 10/11/2023]
Abstract
Acute myocardial infarction (AMI) is associated with high morbidity and mortality worldwide. Although early reperfusion is the most effective strategy to salvage ischemic myocardium, reperfusion injury can develop with the restoration of blood flow. Therefore, it is important to identify protection mechanisms and strategies for the heart after myocardial infarction. Recent studies have shown that multiple intracellular molecules and signaling pathways are involved in cardioprotection. Meanwhile, device-based cardioprotective modalities such as cardiac left ventricular unloading, hypothermia, coronary sinus intervention, supersaturated oxygen (SSO2), and remote ischemic conditioning (RIC) have become important areas of research. Herein, we review the molecular mechanisms of cardioprotection and cardioprotective modalities after ischemia-reperfusion injury (IRI) to identify potential approaches to reduce mortality and improve prognosis in patients with AMI.
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Affiliation(s)
- Honghong Zhang
- Department of Cardiology, Affiliated Hospital of Jiaxing University: First Hospital of Jiaxing, No. 1882 Zhonghuan South Road, Jiaxing, 314000, Zhejiang, People's Republic of China
| | - Huilin Hu
- Department of Cardiology, Affiliated Hospital of Jiaxing University: First Hospital of Jiaxing, No. 1882 Zhonghuan South Road, Jiaxing, 314000, Zhejiang, People's Republic of China.
| | - Changlin Zhai
- Department of Cardiology, Affiliated Hospital of Jiaxing University: First Hospital of Jiaxing, No. 1882 Zhonghuan South Road, Jiaxing, 314000, Zhejiang, People's Republic of China
| | - Lele Jing
- Department of Cardiology, Affiliated Hospital of Jiaxing University: First Hospital of Jiaxing, No. 1882 Zhonghuan South Road, Jiaxing, 314000, Zhejiang, People's Republic of China
| | - Hongen Tian
- Department of Cardiology, Affiliated Hospital of Jiaxing University: First Hospital of Jiaxing, No. 1882 Zhonghuan South Road, Jiaxing, 314000, Zhejiang, People's Republic of China
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Kimura N, Nishimura Y, Chung-Esaki H. Factors Associated with Favorable Outcomes in Cardiac Arrest and Target Temperature Management. Ther Hypothermia Temp Manag 2023. [PMID: 37792291 DOI: 10.1089/ther.2023.0018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/05/2023] Open
Abstract
Current guidelines strongly recommend providing targeted temperature management (TTM) after cardiac arrest, but hypothalamic dysregulation may confound TTM's impact on a patient's ultimate outcome. Although time to reach target temperature has largely been viewed as a process measure for TTM protocols, the difference between initial presenting temperature and target temperature (Δ-temperature) may be a potential surrogate marker of hypothalamic dysregulation. We performed a retrospective observational study to explore whether Δ-temperature was associated with neurologic outcomes and mortality. We included 86 patients (53 with out-of-hospital cardiac arrest [OHCA] and 33 with in-hospital cardiac arrest [IHCA]) in our analysis; more than half of the patients were cooled to 33°C (56.9% in OHCA and 57.6% in IHCA). In univariate logistic regression analysis, Δ-temperature alone did not appear to be statistically associated with mortality or neurologic outcomes regardless of target temperature. In exploratory analysis, longer time from TTM initiation-to-target was associated with worse neurological outcomes in the 33°C target (odds ratio = 0.996, 95% confidence interval = 0.992-1.000). Further research investigating the impact of hypothalamic dysregulation and Δ-temperature as well as the rate of cooling may be warranted to elucidate additional factors contributing to outcomes after cardiac arrest. In addition, our study population was noted to have a higher proportion of Asians and Native Hawaiians/Pacific Islanders, with a potential disparity in outcomes. Future studies may be warranted to ensure generalizability of TTM protocols and findings across populations.
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Affiliation(s)
- Nobuhiko Kimura
- Department of Medicine, John A. Burns School of Medicine, University of Hawai'i, Honolulu, Hawaii, USA
| | - Yoshito Nishimura
- Department of Medicine, John A. Burns School of Medicine, University of Hawai'i, Honolulu, Hawaii, USA
| | - Hangyul Chung-Esaki
- Department of Medicine, John A. Burns School of Medicine, University of Hawai'i, Honolulu, Hawaii, USA
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Li P, Sun Z, Tian T, Yu D, Tian H, Gong P. Recent developments and controversies in therapeutic hypothermia after cardiopulmonary resuscitation. Am J Emerg Med 2023; 64:1-7. [PMID: 36435004 DOI: 10.1016/j.ajem.2022.11.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 10/23/2022] [Accepted: 11/01/2022] [Indexed: 11/13/2022] Open
Abstract
Therapeutic hypothermia was recommended as the only neuroprotective treatment in comatose patients after return of spontaneous circulation (ROSC). With new evidence suggesting a similar neuroprotective effect of 36 °C and 33 °C, the term "therapeutic hypothermia" was substituted by "targeted temperature management" in 2011, which in turn was replaced by the term "temperature control" in 2022 because of new evidence of the similar effects of target normothermia and 33 °C. However, there is no clear consensus on the efficacy of therapeutic hypothermia. In this article, we provide an overview of the recent evidence from basic and clinical research related to therapeutic hypothermia and re-evaluate its application as a post-ROSC neuroprotective intervention in clinical settings.
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Affiliation(s)
- Peijuan Li
- Department of Emergency, First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China; Dalian Medical University, Dalian, Liaoning, China
| | - Zhangping Sun
- Department of Emergency, First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China; Dalian Medical University, Dalian, Liaoning, China
| | - Tian Tian
- Department of Emergency, First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China; Dalian Medical University, Dalian, Liaoning, China
| | - Dongping Yu
- Department of Emergency, Second Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Hui Tian
- Department of Emergency, Dalian Municipal Central Hospital, Dalian, Liaoning, China
| | - Ping Gong
- Department of Emergency, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, Guangdong, China; Department of Emergency, First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China.
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Tingle SJ, Hoather TJ, Thompson ER, Wilson C. Therapeutic donor hypothermia following brain death to improve the quality of transplanted organs. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2023; 2023:CD015190. [PMCID: PMC9878618 DOI: 10.1002/14651858.cd015190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
This is a protocol for a Cochrane Review (intervention). The objectives are as follows: This review aims to examine the benefits and harms of therapeutic donor hypothermia in recipients or organs donated after brain death.
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Affiliation(s)
| | - Samuel J Tingle
- NIHR Blood and Transplant Research UnitNewcastle University and Cambridge UniversityNewcastle upon TyneUK
| | - Thomas J Hoather
- Department of EducationNewcastle UniversityNewcastle Upon TyneUK
| | - Emily R Thompson
- Institute of TransplantationThe Freeman HospitalNewcastle upon TyneUK
| | - Colin Wilson
- Institute of TransplantationThe Freeman HospitalNewcastle upon TyneUK
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Novel therapeutic strategies to reduce reperfusion injury after acute myocardial infarction. Curr Probl Cardiol 2022; 47:101398. [PMID: 36108813 DOI: 10.1016/j.cpcardiol.2022.101398] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 09/07/2022] [Indexed: 02/06/2023]
Abstract
For almost 30 years, urgent revascularization termed primary percutaneous coronary intervention (pPCI) has been a cornerstone of modern care for acute myocardial infarction (AMI). It lowers mortality and improved cardiovascular outcome compared to conservative therapy including thrombolysis. Reperfusion injury, which occurs after successful re-opening of the formerly occluded coronary artery, had been exploited as a potential therapeutic target. When revascularisation became faster and pPCI was successfully performed within 60-90 minutes of symptom onset, the interest in a potential additive effect of targeting reperfusion injury vanished. More recently, several meta-analyses indicated that limiting reperfusion injury prevents microvascular obstruction and reduces final infarct size, thereby lowering the probability of heart failure events and improving quality of life in AMI survivors. Here, we describe the current strategies to limit reperfusion injury and to improve post-AMI outcomes such as systemic or intracoronary hypothermia, left-ventricular unloading, intracoronary infusion of super-saturated oxygen, intermittent coronary sinus occlusion, and C-reactive protein apharesis.
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Akin M, Sieweke JT, Garcheva V, Martinez CS, Adel J, Plank P, Zandian P, Sühs KW, Bauersachs J, Schäfer A. Additive Impact of Interleukin 6 and Neuron Specific Enolase for Prognosis in Patients With Out-of-Hospital Cardiac Arrest – Experience From the HAnnover COoling REgistry. Front Cardiovasc Med 2022; 9:899583. [PMID: 35711345 PMCID: PMC9194609 DOI: 10.3389/fcvm.2022.899583] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 05/13/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundPatients after out-of-hospital cardiac arrest (OHCA) are at increased risk for mortality and poor neurological outcome. We assessed the additive impact of interleukin 6 (IL-6) at admission to neuron-specific enolase (NSE) at day 3 for prognosis of 30-day mortality and long-term neurological outcome in OHCA patients.MethodsA total of 217 patients from the HAnnover COoling REgistry with return of spontaneous circulation (ROSC) after OHCA and IL-6 measurement immediately after admission during 2017–2020 were included to investigate the prognostic value and importance of IL-6 in addition to NSE obtained on day 3. Poor neurological outcome was defined by cerebral performance category (CPC) ≥ 3 after 6 months.ResultsPatients with poor outcome showed higher IL-6 values (30-day mortality: 2,224 ± 524 ng/l vs 186 ± 15 ng/l, p < 0.001; CPC ≥ 3 at 6 months: 1,440 ± 331 ng/l vs 180 ± 24 ng/l, p < 0.001). IL-6 was an independent predictor of mortality (HR = 1.013/ng/l; 95% CI 1.007–1.019; p < 0.001) and poor neurological outcome (HR = 1.004/ng/l; 95% CI 1.001–1.007; p = 0.036). In ROC-analysis, AUC for IL-6 was 0.98 (95% CI 0.96–0.99) for mortality, but only 0.76 (95% CI 0.68–0.84) for poor neurological outcome. The determined cut-off value for IL-6 was 431 ng/l for mortality (NPV 89.2%). In patients with IL-6 > 431 ng/l, the combination with NSE < 46 μg/l optimally identified those individuals with potential for good neurological outcome (CPC ≤ 2).ConclusionElevated IL-6 levels at admission after ROSC were closely associated with 30-day mortality. The combination of IL-6 and NSE provided clinically important additive information for predict poor neurological outcome at 6 months.
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Affiliation(s)
- Muharrem Akin
- Cardiac Arrest Center, Department of Cardiology and Angiology, Hannover Medical School, Hanover, Germany
- *Correspondence: Muharrem Akin,
| | - Jan-Thorben Sieweke
- Cardiac Arrest Center, Department of Cardiology and Angiology, Hannover Medical School, Hanover, Germany
| | - Vera Garcheva
- Cardiac Arrest Center, Department of Cardiology and Angiology, Hannover Medical School, Hanover, Germany
| | - Carolina Sanchez Martinez
- Cardiac Arrest Center, Department of Cardiology and Angiology, Hannover Medical School, Hanover, Germany
| | - John Adel
- Cardiac Arrest Center, Department of Cardiology and Angiology, Hannover Medical School, Hanover, Germany
| | - Pia Plank
- Cardiac Arrest Center, Department of Cardiology and Angiology, Hannover Medical School, Hanover, Germany
| | - Paris Zandian
- Cardiac Arrest Center, Department of Cardiology and Angiology, Hannover Medical School, Hanover, Germany
| | | | - Johann Bauersachs
- Cardiac Arrest Center, Department of Cardiology and Angiology, Hannover Medical School, Hanover, Germany
| | - Andreas Schäfer
- Cardiac Arrest Center, Department of Cardiology and Angiology, Hannover Medical School, Hanover, Germany
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Skrifvars MB, Kurola J. The 2022 Finnish Current Care Guidelines for Cardiopulmonary Resuscitation recommend avoiding fever and not mild therapeutic hypothermia in unconscious patients after cardiac arrest. Acta Anaesthesiol Scand 2022; 66:427-429. [PMID: 35090040 DOI: 10.1111/aas.14027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 01/15/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Markus B. Skrifvars
- Department of Emergency Care and Services Helsinki University Hospital and University of Helsinki Helsinki Finland
| | - Jouni Kurola
- Centre for Prehospital Emergency Care Kuopio University Hospital and University of Eastern Finland Kuopio Finland
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Scholte NTB, van Wees C, Rietdijk WJR, van der Graaf M, Jewbali LSD, van der Jagt M, van den Berg RCM, Lenzen MJ, den Uil CA. Clinical Outcomes with Targeted Temperature Management (TTM) in Comatose Out-of-Hospital Cardiac Arrest Patients-A Retrospective Cohort Study. J Clin Med 2022; 11:jcm11071786. [PMID: 35407394 PMCID: PMC8999846 DOI: 10.3390/jcm11071786] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 03/22/2022] [Accepted: 03/23/2022] [Indexed: 01/23/2023] Open
Abstract
Purpose: we evaluated the effects of the shift of a targeted temperature management (TTM) strategy from 33 °C to 36 °C in comatose out-of-hospital cardiac arrest (OHCA) patients admitted to the Intensive Care Unit (ICU). Methods: we performed a retrospective study of all comatose (GCS < 8) OHCA patients treated with TTM from 2010 to 2018 (n = 798) from a single-center academic hospital. We analyzed 90-day mortality, and neurological outcome (CPC score) at ICU discharge and ICU length of stay, as primary and secondary outcomes, respectively. Results: we included 798 OHCA patients (583 in the TTM33 group and 215 in the TTM36 group). We found no association between the TTM strategy (TTM33 and TTM36) and 90-day mortality (hazard ratio (HR)] 0.877, 95% CI 0.677−1.135, with TTM36 as reference). Also, no association was found between TTM strategy and favorable neurological outcome at ICU discharge (odds ratio (OR) 1.330, 95% CI 0.941−1.879). Patients in the TTM33 group had on average a longer ICU LOS (beta 1.180, 95% CI 0.222−2.138). Conclusion: no differences in clinical outcomes—both 90-day mortality and favorable neurological outcome at ICU discharge—were found between targeted temperature at 33 °C and 36 °C. These results may help to corroborate previous trial findings and assist in implementation of TTM.
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Affiliation(s)
- Niels T. B. Scholte
- Department of Cardiology, Erasmus MC—University Medical Center, 3015 GD Rotterdam, The Netherlands; (C.v.W.); (M.v.d.G.); (L.S.D.J.); (M.J.L.)
- Correspondence:
| | - Christiaan van Wees
- Department of Cardiology, Erasmus MC—University Medical Center, 3015 GD Rotterdam, The Netherlands; (C.v.W.); (M.v.d.G.); (L.S.D.J.); (M.J.L.)
- Department of Intensive Care, Erasmus MC—University Medical Center, 3015 GD Rotterdam, The Netherlands;
| | - Wim J. R. Rietdijk
- Department of Hospital Pharmacy, Erasmus MC—University Medical Center, 3015 GD Rotterdam, The Netherlands;
| | - Marisa van der Graaf
- Department of Cardiology, Erasmus MC—University Medical Center, 3015 GD Rotterdam, The Netherlands; (C.v.W.); (M.v.d.G.); (L.S.D.J.); (M.J.L.)
| | - Lucia S. D. Jewbali
- Department of Cardiology, Erasmus MC—University Medical Center, 3015 GD Rotterdam, The Netherlands; (C.v.W.); (M.v.d.G.); (L.S.D.J.); (M.J.L.)
- Department of Intensive Care, Erasmus MC—University Medical Center, 3015 GD Rotterdam, The Netherlands;
| | - Mathieu van der Jagt
- Department of Intensive Care, Erasmus MC—University Medical Center, 3015 GD Rotterdam, The Netherlands;
| | | | - Mattie J. Lenzen
- Department of Cardiology, Erasmus MC—University Medical Center, 3015 GD Rotterdam, The Netherlands; (C.v.W.); (M.v.d.G.); (L.S.D.J.); (M.J.L.)
| | - Corstiaan A. den Uil
- Department of Intensive Care, Maasstad Hospital, 3079 DZ Rotterdam, The Netherlands;
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