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Liu B, Li M, Wang J, Zhang F, Wang F, Jin C, Li J, Wang Y, Sanderson TH, Zhang R. The role of magnesium in cardiac arrest. Front Nutr 2024; 11:1387268. [PMID: 38812935 PMCID: PMC11133868 DOI: 10.3389/fnut.2024.1387268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2024] [Accepted: 04/22/2024] [Indexed: 05/31/2024] Open
Abstract
Cardiac arrest is a leading cause of death globally. Only 25.8% of in-hospital and 33.5% of out-of-hospital individuals who achieve spontaneous circulation following cardiac arrest survive to leave the hospital. Respiratory failure and acute coronary syndrome are the two most common etiologies of cardiac arrest. Effort has been made to improve the outcomes of individuals resuscitated from cardiac arrest. Magnesium is an ion that is critical to the function of all cells and organs. It is often overlooked in everyday clinical practice. At present, there have only been a small number of reviews discussing the role of magnesium in cardiac arrest. In this review, for the first time, we provide a comprehensive overview of magnesium research in cardiac arrest focusing on the effects of magnesium on the occurrence and prognosis of cardiac arrest, as well as in the two main diseases causing cardiac arrest, respiratory failure and acute coronary syndrome. The current findings support the view that magnesium disorder is associated with increased risk of cardiac arrest as well as respiratory failure and acute coronary syndrome.
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Affiliation(s)
- Baoshan Liu
- School of Clinical Medicine, Shandong Second Medical University, Weifang People’s Hospital, Weifang, China
- Department of Cardiology, Key Laboratory of Cardiopulmonary-Cerebral Resuscitation Research of Weifang, The First Affiliated Hospital of Shandong Second Medical University, Weifang People’s Hospital, Weifang, China
| | - Muyuan Li
- School of Clinical Medicine, Shandong Second Medical University, Weifang People’s Hospital, Weifang, China
- Department of Cardiology, Key Laboratory of Cardiopulmonary-Cerebral Resuscitation Research of Weifang, The First Affiliated Hospital of Shandong Second Medical University, Weifang People’s Hospital, Weifang, China
| | - Jian Wang
- School of Clinical Medicine, Shandong Second Medical University, Weifang People’s Hospital, Weifang, China
- Department of Cardiology, Key Laboratory of Cardiopulmonary-Cerebral Resuscitation Research of Weifang, The First Affiliated Hospital of Shandong Second Medical University, Weifang People’s Hospital, Weifang, China
| | - Fengli Zhang
- School of Clinical Medicine, Shandong Second Medical University, Weifang People’s Hospital, Weifang, China
- Department of Cardiology, Key Laboratory of Cardiopulmonary-Cerebral Resuscitation Research of Weifang, The First Affiliated Hospital of Shandong Second Medical University, Weifang People’s Hospital, Weifang, China
| | - Fangze Wang
- School of Clinical Medicine, Shandong Second Medical University, Weifang People’s Hospital, Weifang, China
- Department of Cardiology, Key Laboratory of Cardiopulmonary-Cerebral Resuscitation Research of Weifang, The First Affiliated Hospital of Shandong Second Medical University, Weifang People’s Hospital, Weifang, China
| | - Caicai Jin
- School of Clinical Medicine, Shandong Second Medical University, Weifang People’s Hospital, Weifang, China
- Department of Cardiology, Key Laboratory of Cardiopulmonary-Cerebral Resuscitation Research of Weifang, The First Affiliated Hospital of Shandong Second Medical University, Weifang People’s Hospital, Weifang, China
| | - Jiayi Li
- School of Clinical Medicine, Shandong Second Medical University, Weifang People’s Hospital, Weifang, China
- Department of Cardiology, Key Laboratory of Cardiopulmonary-Cerebral Resuscitation Research of Weifang, The First Affiliated Hospital of Shandong Second Medical University, Weifang People’s Hospital, Weifang, China
| | - Yanran Wang
- Department of Cardiology, Key Laboratory of Cardiopulmonary-Cerebral Resuscitation Research of Weifang, The First Affiliated Hospital of Shandong Second Medical University, Weifang People’s Hospital, Weifang, China
- School of Anesthesiology, Shandong Second Medical University, Weifang, China
| | - Thomas Hudson Sanderson
- Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, MI, United States
| | - Rui Zhang
- School of Clinical Medicine, Shandong Second Medical University, Weifang People’s Hospital, Weifang, China
- Department of Cardiology, Key Laboratory of Cardiopulmonary-Cerebral Resuscitation Research of Weifang, The First Affiliated Hospital of Shandong Second Medical University, Weifang People’s Hospital, Weifang, China
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Barlow B, Landolf K, LaPlante R, Cercone J, Kim JY, Ghorashi S, Howell A, Armahizer M, Heavner MS. Electrolyte considerations in targeted temperature management. Am J Health Syst Pharm 2023; 80:102-110. [PMID: 36269999 DOI: 10.1093/ajhp/zxac307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Indexed: 01/26/2023] Open
Abstract
PURPOSE Targeted temperature management (TTM), including normothermia and therapeutic hypothermia, is used primarily for comatose patients with return of spontaneous circulation after cardiac arrest or following neurological injury. Despite the potential benefits of TTM, risks associated with physiological alterations, including electrolyte shifts, may require intervention. SUMMARY This review describes the normal physiological balance of electrolytes and temperature-related alterations as well as the impact of derangements on patient outcomes, providing general recommendations for repletion and monitoring of key electrolytes, including potassium, phosphate, and magnesium. CONCLUSION Frequent monitoring and consideration of patient variables such as renal function and other risk factors for adverse effects are important areas of awareness for clinicians caring for patients undergoing TTM.
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Affiliation(s)
- Brooke Barlow
- Memorial Hermann Woodlands Medical Center, Shenandoah, TX, USA
| | - Kaitlin Landolf
- Department of Pharmacy Practice and Science, University of Maryland School of Pharmacy, Baltimore, MD, USA
| | - Reid LaPlante
- Department of Pharmacy, University of Maryland Medical Center, Baltimore, MD, USA
| | - Jessica Cercone
- Department of Pharmacy, St. Clair Health, Pittsburgh, PA, USA
| | - Ji-Yeon Kim
- Department of Pharmacy, Sinai Hospital of Baltimore, Baltimore, MD, USA
| | - Sona Ghorashi
- Department of Pharmacy Practice and Science, University of Maryland School of Pharmacy, Baltimore, MD, USA
| | - Alexandria Howell
- Department of Pharmacy Practice and Science, University of Maryland School of Pharmacy, Baltimore, MD, USA
| | - Michael Armahizer
- Department of Pharmacy, University of Maryland Medical Center, Baltimore, MD, USA
| | - Mojdeh S Heavner
- Department of Pharmacy Practice and Science, University of Maryland School of Pharmacy, Baltimore, MD, USA
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Kirkegaard H, Grejs AM, Gudbjerg S, Duez C, Jeppesen A, Hassager C, Laitio T, Storm C, Taccone FS, Skrifvars MB, Søreide E. Electrolyte profiles with induced hypothermia: A sub study of a clinical trial evaluating the duration of hypothermia after cardiac arrest. Acta Anaesthesiol Scand 2022; 66:615-624. [PMID: 35218019 PMCID: PMC9311071 DOI: 10.1111/aas.14053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 01/20/2022] [Accepted: 02/16/2022] [Indexed: 11/29/2022]
Abstract
Background Electrolyte disturbances can result from targeted temperature treatment (TTM) in out‐of‐hospital cardiac arrest (OHCA) patients. This study explores electrolyte changes in blood and urine in OHCA patients treated with TTM. Methods This is a sub‐study of the TTH48 trial, with the inclusion of 310 unconscious OHCA patients treated with TTM at 33°C for 24 or 48 h. Over a three‐day period, serum concentrations were obtained on sodium potassium, chloride, ionized calcium, magnesium and phosphate, as were results from a 24‐h diuresis and urine electrolyte concentration and excretion. Changes over time were analysed with a mixed‐model multivariate analysis of variance with repeated measurements. Results On admission, mean ± SD sodium concentration was 138 ± 3.5 mmol/l, which increased slightly but significantly (p < .05) during the first 24 h. Magnesium concentration stayed within the reference interval. Median ionized calcium concentration increased from 1.11 (IQR 1.1–1.2) mmol/l during the first 24 h (p < .05), whereas median phosphate concentration dropped to 1.02 (IQR 0.8–1.2) mmol/l (p < .05) and stayed low. During rewarming, potassium concentrations increased, and magnesium and ionizes calcium concentration decreased (p < .05). Median 24‐h diuresis results on days one and two were 2198 and 2048 ml respectively, and the electrolyte excretion mostly stayed low in the reference interval. Conclusions Electrolytes mostly remained within the reference interval. A temporal change occurred in potassium, magnesium and calcium concentrations with TTM’s different phases. No hypothermia effect on diuresis was detected, and urine excretion of electrolytes mostly stayed low.
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Affiliation(s)
- Hans Kirkegaard
- Research Center for Emergency Medicine, Emergency Department Aarhus University Hospital Aarhus Denmark
- Research Center for Emergency Medicine, Department of Clinical Medicine Aarhus University Aarhus Denmark
| | - Anders M. Grejs
- Department of Intensive Care Aarhus University Hospital Aarhus Denmark
- Department of Clinical Medicine Aarhus University Aarhus Denmark
| | - Simon Gudbjerg
- Department of Anaesthesia and Intensive Care Aalborg University Hospital Aalborg Denmark
| | - Christophe Duez
- Department of Intensive Care Aarhus University Hospital Aarhus Denmark
| | - Anni Jeppesen
- Department of Intensive Care Aarhus University Hospital Aarhus Denmark
| | - Christian Hassager
- Department of Cardiology Rigshospitalet Copenhagen Denmark
- Department of Clinical Medicine University of Copenhagen Copenhagen Denmark
| | - Timo Laitio
- Division of Perioperative Services, Intensive Care Medicine and Pain Management Turku University Hospital, University of Turku Finland
| | - Christian Storm
- Department of Internal Medicine, Nephrology and Intensive Care Charité‐Universitätsmedizin Berlin Berlin Germany
| | - Fabio Silvio Taccone
- Department of Intensive Care Erasme Hospital, Université Libre de Bruxelles Brussels Belgium
| | - Markus B. Skrifvars
- Department of Anaesthesiology, Intensive Care and Paine Medicine University of Helsinki, Helsinki University Hospital Helsinki Finland
- Department of Emergency Care and Services University of Helsinki and Helsinki University Hospital Helsinki Finland
| | - Eldar Søreide
- Critical Care and Anaesthesiology Research Group Stavanger University Hospital Stavanger Norway
- Department of Clinical Medicine University of Bergen Bergen Norway
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Kumar M, Perucki W, Hiendlmayr B, Mazigh S, O'Sullivan DM, Fernandez AB. The Association of Serum Magnesium Levels and QT Interval with Neurological Outcomes After Targeted Temperature Management. Ther Hypothermia Temp Manag 2022; 12:210-214. [PMID: 35467975 DOI: 10.1089/ther.2021.0038] [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: 11/12/2022] Open
Abstract
Targeted temperature management (TTM) is associated with corrected QT (QTc) prolongation and decrease in serum magnesium (Mg) levels that may lead to recurrent ventricular arrhythmia and poor neurological outcomes. We aimed to evaluate the association between QTc interval and Mg levels during TTM with neurological outcomes. We reviewed the electrocardiograms of 366 patients who underwent TTM during the induction, maintenance, and rewarming phase after cardiac arrest. We reviewed the association of change in QTc interval, and Mg levels with neurological outcomes. In total, 71.3% of the patients had a significant increase in QTc interval defined as >60 ms or any QTc >500 ms during TTM. Poor neurological outcome was associated with persistent prolongation of QTc after rewarming (507 vs. 483 ms, p = 0.046) and higher Mg levels at presentation (2.08 ± 0.41 mg/dL, p = 0.014). Supplemental Mg did not have any significant change in their QTc. Patients with prolonged QTc during TTM should be promptly evaluated for QTc-prolonging factors given its association with worse neurological outcomes. The inverse correlation between Mg levels and poor neurological outcomes deserves further investigation.
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Affiliation(s)
- Manish Kumar
- Department of Medicine, Pat and Jim Calhoun Cardiology Center, University of Connecticut School of Medicine, Farmington, Connecticut, USA
| | - William Perucki
- Department of Medicine, Pat and Jim Calhoun Cardiology Center, University of Connecticut School of Medicine, Farmington, Connecticut, USA.,Division of Cardiology, Hartford Hospital, Hartford, Connecticut, USA
| | - Brett Hiendlmayr
- Division of Cardiology, Hartford Hospital, Hartford, Connecticut, USA
| | - Silya Mazigh
- Department of Medicine, Pat and Jim Calhoun Cardiology Center, University of Connecticut School of Medicine, Farmington, Connecticut, USA
| | - David M O'Sullivan
- Department of Research, Research Administration, Hartford HealthCare, Hartford, Connecticut, USA
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PROLOGUE (PROgnostication using LOGistic regression model for Unselected adult cardiac arrest patients in the Early stages): Development and validation of a scoring system for early prognostication in unselected adult cardiac arrest patients. Resuscitation 2020; 159:60-68. [PMID: 33388366 DOI: 10.1016/j.resuscitation.2020.12.022] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 11/26/2020] [Accepted: 12/18/2020] [Indexed: 12/27/2022]
Abstract
BACKGROUND Early prognostication after cardiac arrest would be useful. We aimed to develop a scoring model for early prognostication in unselected adult cardiac arrest patients. METHODS We retrospectively analysed data of adult non-traumatic cardiac arrest patients treated at a tertiary hospital between 2014 and 2018. The primary outcome was poor outcome at hospital discharge (cerebral performance category, 3-5). Using multivariable logistic regression analysis, independent predictors were identified among known outcome predictors, that were available at intensive care unit admission, in patients admitted in the first 3 years (derivation set, N = 671), and a scoring system was developed with the variables that were retained in the final model. The scoring model was validated in patients admitted in the last 2 years (validation set, N = 311). RESULTS The poor outcome rates at hospital discharge were similar between the derivation (66.0%) and validation sets (64.3%). Age <59 years, witnessed collapse, shockable rhythm, adrenaline dose <2 mg, low-flow duration <18 min, reactive pupillary light reflex, Glasgow Coma Scale motor score ≥2, and levels of creatinine <1.21 mg dl-1, potassium <4.4 mEq l-1, phosphate <5.8 mg dl-1, haemoglobin ≥13.2 g dl-1, and lactate <8 mmol l-1 were retained in the final multivariable model and used to develop the scoring system. Our model demonstrated excellent discrimination in the validation set (area under the curve of 0.942, 95% confidence interval 0.917-0.968). CONCLUSIONS We developed a scoring model for early prognostication in unselected adult cardiac arrest patients. Further validations in various cohorts are needed.
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Panchal AR, Bartos JA, Cabañas JG, Donnino MW, Drennan IR, Hirsch KG, Kudenchuk PJ, Kurz MC, Lavonas EJ, Morley PT, O’Neil BJ, Peberdy MA, Rittenberger JC, Rodriguez AJ, Sawyer KN, Berg KM, Arafeh J, Benoit JL, Chase M, Fernandez A, de Paiva EF, Fischberg BL, Flores GE, Fromm P, Gazmuri R, Gibson BC, Hoadley T, Hsu CH, Issa M, Kessler A, Link MS, Magid DJ, Marrill K, Nicholson T, Ornato JP, Pacheco G, Parr M, Pawar R, Jaxton J, Perman SM, Pribble J, Robinett D, Rolston D, Sasson C, Satyapriya SV, Sharkey T, Soar J, Torman D, Von Schweinitz B, Uzendu A, Zelop CM, Magid DJ. Part 3: Adult Basic and Advanced Life Support: 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 2020; 142:S366-S468. [DOI: 10.1161/cir.0000000000000916] [Citation(s) in RCA: 371] [Impact Index Per Article: 92.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Mandigers L, Termorshuizen F, de Keizer NF, Gommers D, Dos Reis Miranda D, Rietdijk WJR, den Uil CA. A nationwide overview of 1-year mortality in cardiac arrest patients admitted to intensive care units in the Netherlands between 2010 and 2016. Resuscitation 2020; 147:88-94. [PMID: 31926259 DOI: 10.1016/j.resuscitation.2019.12.029] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 12/11/2019] [Accepted: 12/27/2019] [Indexed: 11/25/2022]
Abstract
AIM Worldwide, cardiac arrest (CA) remains a major cause of death. Most post-CA patients are admitted to the intensive care unit (ICU). The aim of this study is to describe mortality rates and possible changes in mortality rates in patients with CA admitted to the ICU in the Netherlands between 2010 and 2016. METHODS In this study, we included all adult CA patients registered in the National Intensive Care Evaluation (NICE) registry who were admitted to ICUs in the Netherlands between 2010 and 2016. The primary outcome was 1-year mortality which was analysed by Cox regression. The secondary outcomes were ICU mortality and hospital mortality. Hospital mortality was analysed by binary logistic regression analysis. Patients were stratified by whether they experienced in-hospital cardiac arrest (IHCA) or out-of-hospital cardiac arrest (OHCA). Finally, the outcome over calendar time was assessed for both groups. RESULTS We included 26,056 CA patients: 10,618 (40.8%) IHCA patients and 14,482 (55.6%) OHCA patients. The 1-year mortality rate was 57.5%: 59% for IHCA and 56.4% for OHCA, p < 0.01. This mortality rate remained stable between 2010 and 2016 for IHCA (p = 0.31) and declined for OHCA patients (p = 0.01). The hospital mortality rate was 50.3%: 50.5% for IHCA and 50.2% for OHCA, p = 0.66. This mortality rate remained stable between 2010-2016 for IHCA (p = 0.21) and decreased for OHCA patients (p < 0.01). An additional analysis with calendar year as a continuous variable showed a mortality decline of 1.56% per calendar year for 1-year mortality. CONCLUSION This nationwide registry cohort study reported a 57.5% 1-year mortality rate for CA patients admitted to the ICU between 2010 and 2016. We reported a decline in 1-year mortality for OHCA patients in these years.
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Affiliation(s)
- Loes Mandigers
- Department of Intensive Care, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
| | - Fabian Termorshuizen
- National Intensive Care Evaluation (NICE) Foundation, Amsterdam, The Netherlands; Department of Medical Informatics, Amsterdam UMC, Amsterdam Public Health Research Institute, University of Amsterdam, Amsterdam, The Netherlands
| | - Nicolette F de Keizer
- National Intensive Care Evaluation (NICE) Foundation, Amsterdam, The Netherlands; Department of Medical Informatics, Amsterdam UMC, Amsterdam Public Health Research Institute, University of Amsterdam, Amsterdam, The Netherlands
| | - Diederik Gommers
- Department of Intensive Care, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Dinis Dos Reis Miranda
- Department of Intensive Care, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Wim J R Rietdijk
- Department of Intensive Care, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Corstiaan A den Uil
- Department of Intensive Care, Erasmus MC University Medical Center, Rotterdam, The Netherlands; Department of Cardiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
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Suzuki M, Hatakeyama T, Nakamura R, Saiki T, Kamisasanuki T, Sugiki D, Matsushima H. Serum Magnesium Levels and Neurological Outcomes in Patients Undergoing Targeted Temperature Management After Cardiac Arrest. J Emerg Nurs 2020; 46:59-65. [DOI: 10.1016/j.jen.2019.10.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 09/18/2019] [Accepted: 10/04/2019] [Indexed: 10/25/2022]
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Ueda Y, Oda Y, Povlishock JT, Wei EP. Mechanisms Associated with the Adverse Vascular Consequences of Rapid Posthypothermic Rewarming and Their Therapeutic Modulation in Rats. Ther Hypothermia Temp Manag 2019; 10:204-210. [PMID: 31433258 DOI: 10.1089/ther.2019.0022] [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: 11/13/2022] Open
Abstract
We previously demonstrated that rapid posthypothermic rewarming in noninjured animals was capable of damaging cerebral arterioles both at endothelial and smooth muscle levels. Such adverse consequences could be prevented with antioxidants, suggesting the involvement of free radicals. In this study, we further investigate the mechanisms associated with free radicals production by using two radical scavengers, superoxide dismutase (SOD) and catalase. Employing rats, the cerebral vascular response was evaluated at 2, 3, and 4 hours after onset of hypothermia. Before rapid rewarming, SOD treatment, but not catalase, preserved the NO-mediated dilation induced by acetylcholine (ACh). On the contrary, catalase preserved the hypercapnia-induced relaxation of the smooth muscle cells, whereas SOD offered only partial protection. Adding SOD to catalase treatment offered no additional benefit. These results suggest that rapid posthypothermic rewarming impairs ACh- and hypercapnia-induced vasodilation through different subcellular mechanisms. In the case of diminished vascular response to ACh, it appears to act on the endothelial front primarily by superoxide anions, as evidenced by its full preservation after SOD treatment. In terms of impaired dilation to hypercapnia, hydrogen peroxide and/or its derivatives are the likely candidates in targeting the smooth muscle cells. The partial protection of SOD to hypercapnia-induced dilation is believed to be the reduced amount of superoxide that would otherwise spontaneously dismutate to produce hydrogen peroxide. Although SOD exerts some indirect influence on the hydrogen peroxide production downstream, catalase apparently has no influence on upstream superoxide production.
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Affiliation(s)
- Yuji Ueda
- Department of Neurosurgery, Tokuyama Central Hospital, Yamaguchi, Japan
| | - Yasutaka Oda
- Advanced Medical Emergency and Critical Care Center, Yamaguchi University Hospital, Yamaguchi, Japan
| | - John T Povlishock
- Department of Anatomy and Neurobiology, Virginia Commonwealth University, Richmond, Virginia
| | - Enoch P Wei
- Department of Anatomy and Neurobiology, Virginia Commonwealth University, Richmond, Virginia
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Ion shift index as a promising prognostic indicator in adult patients resuscitated from cardiac arrest. Resuscitation 2019; 137:116-123. [DOI: 10.1016/j.resuscitation.2019.02.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 02/05/2019] [Accepted: 02/11/2019] [Indexed: 11/21/2022]
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