1
|
Singh A, Heeney M, Montgomery ME. The Pharmacologic Management of Cardiac Arrest. Cardiol Clin 2024; 42:279-288. [PMID: 38631795 DOI: 10.1016/j.ccl.2024.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/19/2024]
Abstract
The effectiveness of pharmacologic management of cardiac arrest patients is widely debated; however, several studies published in the past 5 years have begun to clarify some of these issues. This article covers the current state of evidence for the effectiveness of the vasopressor epinephrine and the combination of vasopressin-steroids-epinephrine and antiarrhythmic medications amiodarone and lidocaine and reviews the role of other medications such as calcium, sodium bicarbonate, magnesium, and atropine in cardiac arrest care. We additionally review the role of β-blockers for refractory pulseless ventricular tachycardia/ventricular fibrillation and thrombolytics in undifferentiated cardiac arrest and suspected fatal pulmonary embolism.
Collapse
Affiliation(s)
- Amandeep Singh
- Alameda Health System, Highland Hospital Emergency Department, 1411 East 31st Street, Oakland, CA 94602, USA.
| | - Megan Heeney
- Alameda Health System, Highland Hospital Emergency Department, 1411 East 31st Street, Oakland, CA 94602, USA
| | - Martha E Montgomery
- Alameda Health System, Highland Hospital Emergency Department, 1411 East 31st Street, Oakland, CA 94602, USA
| |
Collapse
|
2
|
Singh A, Heeney M, Montgomery ME. The Pharmacologic Management of Cardiac Arrest. Emerg Med Clin North Am 2023; 41:559-572. [PMID: 37391250 DOI: 10.1016/j.emc.2023.03.010] [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: 07/02/2023]
Abstract
The effectiveness of pharmacologic management of cardiac arrest patients is widely debated; however, several studies published in the past 5 years have begun to clarify some of these issues. This article covers the current state of evidence for the effectiveness of the vasopressor epinephrine and the combination of vasopressin-steroids-epinephrine and antiarrhythmic medications amiodarone and lidocaine and reviews the role of other medications such as calcium, sodium bicarbonate, magnesium, and atropine in cardiac arrest care. We additionally review the role of β-blockers for refractory pulseless ventricular tachycardia/ventricular fibrillation and thrombolytics in undifferentiated cardiac arrest and suspected fatal pulmonary embolism.
Collapse
Affiliation(s)
- Amandeep Singh
- Alameda Health System, Highland Hospital Emergency Department, 1411 East 31st Street, Oakland, CA 94602, USA.
| | - Megan Heeney
- Alameda Health System, Highland Hospital Emergency Department, 1411 East 31st Street, Oakland, CA 94602, USA
| | - Martha E Montgomery
- Alameda Health System, Highland Hospital Emergency Department, 1411 East 31st Street, Oakland, CA 94602, USA
| |
Collapse
|
3
|
Lee SE, Kim HH, Chae MK, Park EJ, Choi S. Predictive Value of Estimated Lean Body Mass for Neurological Outcomes after Out-of-Hospital Cardiac Arrest. J Clin Med 2020; 10:jcm10010071. [PMID: 33379208 PMCID: PMC7794946 DOI: 10.3390/jcm10010071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 12/23/2020] [Accepted: 12/24/2020] [Indexed: 12/13/2022] Open
Abstract
Background: Postcardiac arrest patients with a return of spontaneous circulation (ROSC) are critically ill, and high body mass index (BMI) is ascertained to be associated with good prognosis in patients with a critically ill condition. However, the exact mechanism has been unknown. To assess the effectiveness of skeletal muscles in reducing neuronal injury after the initial damage owing to cardiac arrest, we investigated the relationship between estimated lean body mass (LBM) and the prognosis of postcardiac arrest patients. Methods: This retrospective cohort study included adult patients with ROSC after out-of-hospital cardiac arrest from January 2015 to March 2020. The enrolled patients were allocated into good- and poor-outcome groups (cerebral performance category (CPC) scores 1–2 and 3–5, respectively). Estimated LBM was categorized into quartiles. Multivariate regression models were used to evaluate the association between LBM and a good CPC score. The area under the receiver operating characteristic curve (AUROC) was assessed. Results: In total, 155 patients were analyzed (CPC score 1–2 vs. 3–5, n = 70 vs. n = 85). Patients’ age, first monitored rhythm, no-flow time, presumed cause of arrest, BMI, and LBM were different (p < 0.05). Fourth-quartile LBM (≥48.98 kg) was associated with good neurological outcome of postcardiac arrest patients (odds ratio = 4.81, 95% confidence interval (CI), 1.10–25.55, p = 0.04). Initial high LBM was also a predictor of good neurological outcomes (AUROC of multivariate regression model including LBM: 0.918). Conclusions: Initial LBM above 48.98kg is a feasible prognostic factor for good neurological outcomes in postcardiac arrest patients.
Collapse
Affiliation(s)
- Sung Eun Lee
- Department of Emergency Medicine, School of Medicine, Ajou University, 164 Worldcup-ro, Yeongtong-gu, Suwon 16499, Korea; (S.E.L.); (M.K.C.); (E.J.P.); (S.C.)
- Department of Neurology, School of Medicine, Ajou University, Suwon 16499, Korea
| | - Hyuk Hoon Kim
- Department of Emergency Medicine, School of Medicine, Ajou University, 164 Worldcup-ro, Yeongtong-gu, Suwon 16499, Korea; (S.E.L.); (M.K.C.); (E.J.P.); (S.C.)
- Correspondence: ; Tel.: +82-31-219-7751; Fax: +82-31-219-7760
| | - Minjung Kathy Chae
- Department of Emergency Medicine, School of Medicine, Ajou University, 164 Worldcup-ro, Yeongtong-gu, Suwon 16499, Korea; (S.E.L.); (M.K.C.); (E.J.P.); (S.C.)
| | - Eun Jung Park
- Department of Emergency Medicine, School of Medicine, Ajou University, 164 Worldcup-ro, Yeongtong-gu, Suwon 16499, Korea; (S.E.L.); (M.K.C.); (E.J.P.); (S.C.)
| | - Sangchun Choi
- Department of Emergency Medicine, School of Medicine, Ajou University, 164 Worldcup-ro, Yeongtong-gu, Suwon 16499, Korea; (S.E.L.); (M.K.C.); (E.J.P.); (S.C.)
| |
Collapse
|
4
|
Wollborn J, Siemering S, Steiger C, Buerkle H, Goebel U, Schick MA. Phosphodiesterase-4 inhibition reduces ECLS-induced vascular permeability and improves microcirculation in a rodent model of extracorporeal resuscitation. Am J Physiol Heart Circ Physiol 2019; 316:H751-H761. [PMID: 30681364 DOI: 10.1152/ajpheart.00673.2018] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Extracorporeal circulation can be accompanied by increased vascular permeability leading to pathological fluid balance and organ dysfunction. The second messenger cAMP is involved in capillary permeability and maintains endothelial integrity. The aim of the present study was to evaluate the effect of phosphodiesterase-4 (PDE4) inhibition with rolipram on extracorporeal circulation-induced capillary leakage, microcirculatory dysfunction, and organ injury in rodents. Rats were randomly allocated to the following groups: sham ( n = 5), venoarterial extracorporeal circulation [extracorporeal life support (ECLS), n = 7], ECLS + rolipram ( n = 7), extracorporeal resuscitation (ECPR; n = 7), and ECPR + rolipram ( n = 7). In the groups that underwent ECPR, ECLS-based cardiopulmonary resuscitation (ECPR) was performed after the induction of hypoxic cardiac arrest. Upon return of spontaneous circulation, rolipram was administered intravenously. The mesenteric microcirculation was studied using intravital microscopy, and organ specimens were harvested upon completion of the study. ECLS and ECPR induced a proinflammatory response (cytokines IL-1β, IL-6, and TNF-α). Although PDE4 expression was upregulated in vascular tissue, PDE4 inhibition abrogated impaired microcirculation and capillary leak (albumin extravasation of the sham group: 1 ± 0.03-fold, ECLS group: 1.2 ± 0.05-fold, ECLS + rolipram group: 0.99 ± 0.04-fold, ECPR group: 1.6 ± 0.04-fold, and ECPR + rolipram group: 1.06 ± 0.02-fold from the sham group, P < 0.05). PDE4 inhibition led to stabilization of vascular cAMP levels but did not affect cytokine levels. Capillary leak was reduced, as demonstrated by the decrease of the systemic biomarkers soluble vascular-endothelial cadherin and activated complement 3. Histological analysis revealed reduced injury to the lungs and kidneys after PDE4 inhibition, with a significant decrease in systemic renal damage markers. Our findings demonstrate that extracorporeal circulation causes an inflammatory reaction associated with decreased vascular cAMP levels, increased vascular permeability, and impaired microcirculation. PDE4 inhibition proved to be capable of reducing these side effects in ECLS and ECPR, leading to reduced microcirculatory, renal, and pulmonary injury. NEW & NOTEWORTHY Various complications are common after extracorporeal circulation. Among these, endothelial injury may cause impaired microcirculation and capillary leak. Here, we report that phosphodiesterase-4 inhibition targeting endothelial cAMP is capable of reducing microvascular complications in a rodent model of extracorporeal resuscitation. Microcirculation and vascular permeability are influenced without targeting extracorporeal circulation-induced inflammation. Thus, pulmonary and renal organ protection may be conferred.
Collapse
Affiliation(s)
- Jakob Wollborn
- Department of Anesthesiology and Critical Care, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Faculty of Medicine, University of Freiburg , Germany
| | - Svenja Siemering
- Department of Anesthesiology and Critical Care, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Faculty of Medicine, University of Freiburg , Germany
| | - Christoph Steiger
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology , Cambridge, Massachusetts.,Division of Gastroenterology, Brigham and Women's Hospital, Harvard Medical School , Boston, Massachusetts.,Institute for Pharmacy and Food Chemistry, University of Wuerzburg , Germany
| | - Hartmut Buerkle
- Department of Anesthesiology and Critical Care, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Faculty of Medicine, University of Freiburg , Germany
| | - Ulrich Goebel
- Department of Anesthesiology and Critical Care, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Faculty of Medicine, University of Freiburg , Germany
| | - Martin A Schick
- Department of Anesthesiology and Critical Care, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Faculty of Medicine, University of Freiburg , Germany
| |
Collapse
|
5
|
Hamasaki MY, Machado MCC, Pinheiro da Silva F. Animal models of neuroinflammation secondary to acute insults originated outside the brain. J Neurosci Res 2017; 96:371-378. [DOI: 10.1002/jnr.24184] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Revised: 09/11/2017] [Accepted: 09/12/2017] [Indexed: 12/15/2022]
Affiliation(s)
- Mike Yoshio Hamasaki
- Laboratório de Emergências Clínicas, Faculdade de Medicina FMUSP; Universidade de São Paulo; São Paulo SP Brazil
| | | | - Fabiano Pinheiro da Silva
- Laboratório de Emergências Clínicas, Faculdade de Medicina FMUSP; Universidade de São Paulo; São Paulo SP Brazil
| |
Collapse
|
6
|
Wei W, Xie Y, Lai SC, Liu BF, He YR, Hu H, Cao Y. Benefits of anti-inflammatory therapy in the treatment of ischemia/reperfusion injury in the renal microvascular endothelium of rats with return of spontaneous circulation. Mol Med Rep 2017; 15:4231-4238. [DOI: 10.3892/mmr.2017.6548] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Accepted: 02/14/2017] [Indexed: 11/05/2022] Open
|