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Nakajima S, Matsuyama T, Kandori K, Okada A, Okada Y, Kitamura T, Ohta B. Impact of time to revascularization on outcomes in patients after out-of-hospital cardiac arrest with STEMI. Am J Emerg Med 2024; 79:136-143. [PMID: 38430707 DOI: 10.1016/j.ajem.2024.02.030] [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] [Received: 07/25/2023] [Revised: 02/06/2024] [Accepted: 02/19/2024] [Indexed: 03/05/2024] Open
Abstract
BACKGROUND International guidelines recommend emergency coronary angiography in patients after out-of-hospital cardiac arrest (OHCA) with ST-segment elevation on 12‑lead electrocardiography. However, the association between time to revascularization and outcomes remains unknown. This study aimed to evaluate the association between time to revascularization and outcomes in patients with OHCA due to ST-segment-elevation myocardial infarction (STEMI) who underwent percutaneous coronary intervention (PCI). METHODS This multicenter, retrospective, nationwide observational study included patients aged ≥18 years with OHCA due to STEMI who underwent PCI between 2014 and 2020. The time of the first return of spontaneous circulation (ROSC) was defined as the time of first ROSC during resuscitation, regardless of the pre-hospital or in-hospital setting. The primary outcome was a 1-month favorable neurological outcome, defined as cerebral performance category 1 or 2. Multivariable logistic regression analysis was used to assess the association between the time to revascularization and favorable neurological outcomes. RESULTS A total of 547 patients were included in this analysis. The multivariable logistic regression analysis showed that a shorter time from the first ROSC to revascularization was associated with 1-month favorable neurological outcomes (63/86 [73.3%] in the time from the first ROSC to revascularization ≤60 min group versus 98/193 [50.8%] in the >120 min group; adjusted OR, 0.26; 95% CI, 0.11-0.56; P for trend, 0.015). CONCLUSIONS Shorter time to revascularization was significantly associated with 1-month favorable neurological outcomes in patients with OHCA due to STEMI who underwent PCI.
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Affiliation(s)
- Satoshi Nakajima
- Department of Emergency Medicine, Kyoto Prefectural University of Medicine, Kaji-cho 465, Kamigyo-ku, Kyoto 602-8566, Japan.
| | - Tasuku Matsuyama
- Department of Emergency Medicine, Kyoto Prefectural University of Medicine, Kaji-cho 465, Kamigyo-ku, Kyoto 602-8566, Japan.
| | - Kenji Kandori
- Department of Emergency and Critical Care Medicine, Japanese Red Cross Society, Kyoto Daini Hospital, Haruobi-cho 355-5, Kamigyo-ku, Kyoto 602-0826, Japan
| | - Asami Okada
- Department of Emergency and Critical Care Medicine, Japanese Red Cross Society, Kyoto Daini Hospital, Haruobi-cho 355-5, Kamigyo-ku, Kyoto 602-0826, Japan
| | - Yohei Okada
- Health Services and Systems Research, Duke-NUS Medical School, National University of Singapore, Singapore, Singapore; Department of Preventive Services, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
| | - Tetsuhisa Kitamura
- Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Graduate School of Medicine, Osaka University, Suita, Osaka 565-0871, Japan
| | - Bon Ohta
- Department of Emergency Medicine, Kyoto Prefectural University of Medicine, Kaji-cho 465, Kamigyo-ku, Kyoto 602-8566, Japan.
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Damjanovic D, Pooth JS, Liu Y, Frensch F, Wolkewitz M, Haberstroh J, Doostkam S, Cristina Schmitz HR, Foerster K, Taunyane I, Neubert T, Scherer C, Diel P, Benk C, Beyersdorf F, Trummer G. The Impact of Head Position on Neurological and Histopathological Outcome Following Controlled Automated Reperfusion of the Whole Body (CARL) in a Pig Model. J Clin Med 2023; 12:7054. [PMID: 38002667 PMCID: PMC10672538 DOI: 10.3390/jcm12227054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 10/27/2023] [Accepted: 11/07/2023] [Indexed: 11/26/2023] Open
Abstract
Introduction: Based on extracorporeal circulation, targeted reperfusion strategies have been developed to improve survival and neurologic recovery in refractory cardiac arrest: Controlled Automated Reperfusion of the whoLe Body (CARL). Furthermore, animal and human cadaver studies have shown beneficial effects on cerebral pressure due to head elevation during conventional cardiopulmonary resuscitation. Our aim was to evaluate the impact of head elevation on survival, neurologic recovery and histopathologic outcome in addition to CARL in an animal model. Methods: After 20 min of ventricular fibrillation, 46 domestic pigs underwent CARL, including high, pulsatile extracorporeal blood flow, pH-stat acid-base management, priming with a colloid, mannitol and citrate, targeted oxygen, carbon dioxide and blood pressure management, rapid cooling and slow rewarming. N = 25 were head-up (HUP) during CARL, and N = 21 were supine (SUP). After weaning from ECC, the pigs were extubated and followed up in the animal care facility for up to seven days. Neuronal density was evaluated in neurohistopathology. Results: More animals in the HUP group survived and achieved a favorable neurological recovery, 21/25 (84%) versus 6/21 (29%) in the SUP group. Head positioning was an independent factor in neurologically favorable survival (p < 0.00012). Neurohistopathology showed no significant structural differences between HUP and SUP. Distinct, partly transient clinical neurologic deficits were blindness and ataxia. Conclusions: Head elevation during CARL after 20 min of cardiac arrest independently improved survival and neurologic outcome in pigs. Clinical follow-up revealed transient neurologic deficits potentially attributable to functions localized in the posterior perfusion area, whereas histopathologic findings did not show corresponding differences between the groups. A possible explanation of our findings may be venous congestion and edema as modifiable contributing factors of neurologic injury following prolonged cardiac arrest.
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Affiliation(s)
- Domagoj Damjanovic
- Department of Cardiovascular Surgery, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, D-79106 Freiburg, Germany
| | - Jan-Steffen Pooth
- Department of Emergency Medicine, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, D-79106 Freiburg, Germany
| | - Yechi Liu
- Department of Cardiovascular Surgery, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, D-79106 Freiburg, Germany
| | - Fabienne Frensch
- Department of Cardiovascular Surgery, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, D-79106 Freiburg, Germany
| | - Martin Wolkewitz
- Institute of Medical Biometry and Statistics, Division Methods in Clinical Epidemiology, Faculty of Medicine and Medical Center, University of Freiburg, D-79104 Freiburg, Germany
| | - Joerg Haberstroh
- Experimental Surgery, Center for Experimental Models and Transgenic Service, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Breisacher Str. 66, D-79106 Freiburg, Germany
| | - Soroush Doostkam
- Institute of Neuropathology, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Breisacherstr. 64, D-79106 Freiburg, Germany
| | - Heidi Ramona Cristina Schmitz
- Experimental Surgery, Center for Experimental Models and Transgenic Service, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Breisacher Str. 66, D-79106 Freiburg, Germany
| | - Katharina Foerster
- Center for Experimental Models and Transgenic Service, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Stefan-Meier-Str. 17, D-79104 Freiburg, Germany
| | - Itumeleng Taunyane
- Department of Cardiovascular Surgery, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, D-79106 Freiburg, Germany
| | - Tabea Neubert
- Department of Cardiovascular Surgery, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, D-79106 Freiburg, Germany
| | - Christian Scherer
- Department of Cardiovascular Surgery, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, D-79106 Freiburg, Germany
| | - Patric Diel
- Department of Cardiovascular Surgery, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, D-79106 Freiburg, Germany
| | - Christoph Benk
- Department of Cardiovascular Surgery, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, D-79106 Freiburg, Germany
| | - Friedhelm Beyersdorf
- Department of Cardiovascular Surgery, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, D-79106 Freiburg, Germany
| | - Georg Trummer
- Department of Cardiovascular Surgery, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, D-79106 Freiburg, Germany
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3
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Johannsen CM, Nørholt C, Baltsen C, Eggertsen MA, Magnussen A, Vormfenne L, Mortensen SØ, Hansen ESS, Vammen L, Andersen LW, Granfeldt A. The effects of methylene blue during and after cardiac arrest in a porcine model; a randomized, blinded, placebo-controlled study. Am J Emerg Med 2023; 73:145-153. [PMID: 37659143 DOI: 10.1016/j.ajem.2023.08.041] [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: 03/29/2023] [Revised: 07/04/2023] [Accepted: 08/22/2023] [Indexed: 09/04/2023] Open
Abstract
PURPOSE To evaluate the effect of methylene blue administered as a bolus on return of spontaneous circulation (ROSC), lactate levels, vasopressor requirements, and markers of neurological injury in a clinically relevant pig model of cardiac arrest. MATERIALS AND METHODS 40 anesthetized pigs were subjected to acute myocardial infarction and 7 min of untreated cardiac arrest. Animals were randomized into three groups: one group received saline only (controls), one group received 2 mg/kg methylene blue and saline (MB + saline), and one group received two doses of 2 mg/kg methylene blue (MB + MB). The first intervention was given after the 3rd rhythm analysis, while the second dose was administered one hour after achieving ROSC. Animals underwent intensive care and observation for six hours, followed by cerebral magnetic resonance imaging (MRI). The primary outcome for this study was development in lactate levels after cardiac arrest. Categorical data were compared using Fisher's exact test and pointwise data were analyzed using one-way analysis of variance (ANOVA) or equivalent non-parametric test. Continuous data collected over time were analyzed using a linear mixed effects model. A value of p < .05 was considered statistically significant. RESULTS Lactate levels increased in all groups after cardiac arrest and resuscitation, however lactate levels in the MB + MB group decreased significantly faster compared with the control group (p = .007) and the MB + saline group (p = .02). The proportion of animals achieving initial ROSC was similar across groups: 11/13 (85%) in the control group, 10/13 (77%) in the MB + saline group, and 12/14 (86%) in the MB + MB group (p = .81). Time to ROSC did not differ between groups (p = .67). There was no significant difference in accumulated norepinephrine dose between groups (p = .15). Cerebral glycerol levels were significantly lower in the MB + MB group after resuscitation compared with control group (p = .03). However, MRI data revealed no difference in apparent diffusion coefficient, cerebral blood flow, or dynamic contrast enhanced MR perfusion between groups. CONCLUSION Treatment with a bolus of methylene blue during cardiac arrest and after resuscitation did not significantly improve hemodynamic function. A bolus of methylene blue did not yield the neuroprotective effects that have previously been described in animals receiving methylene blue as an infusion.
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Affiliation(s)
- Cecilie Munch Johannsen
- Department of Anesthesiology and Intensive Care, Aarhus University Hospital, Denmark; Department of Clinical Medicine, Aarhus University, Denmark
| | - Casper Nørholt
- Department of Anesthesiology and Intensive Care, Aarhus University Hospital, Denmark; Department of Clinical Medicine, Aarhus University, Denmark
| | - Cecilie Baltsen
- Department of Anesthesiology and Intensive Care, Aarhus University Hospital, Denmark; Department of Clinical Medicine, Aarhus University, Denmark
| | - Mark A Eggertsen
- Department of Anesthesiology and Intensive Care, Aarhus University Hospital, Denmark; Department of Clinical Medicine, Aarhus University, Denmark
| | | | | | | | - Esben Søvsø Szocska Hansen
- Department of Clinical Medicine, Aarhus University, Denmark; MR Research Centre, Aarhus University, Denmark
| | - Lauge Vammen
- Department of Anesthesiology and Intensive Care, Aarhus University Hospital, Denmark; Department of Clinical Medicine, Aarhus University, Denmark
| | - Lars W Andersen
- Department of Anesthesiology and Intensive Care, Aarhus University Hospital, Denmark; Department of Clinical Medicine, Aarhus University, Denmark; Prehospital Emergency Medical Services, Central Denmark Region, Aarhus, Denmark
| | - Asger Granfeldt
- Department of Anesthesiology and Intensive Care, Aarhus University Hospital, Denmark; Department of Clinical Medicine, Aarhus University, Denmark.
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Kirk ME, Merit VT, Moeslund N, Dragsbaek SJ, Hansen JV, Andersen A, Lyhne MD. Impact of sternotomy and pericardiotomy on cardiopulmonary haemodynamics in a large animal model. Exp Physiol 2023; 108:762-771. [PMID: 36892095 PMCID: PMC10988510 DOI: 10.1113/ep090919] [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: 10/19/2022] [Accepted: 02/14/2023] [Indexed: 03/10/2023]
Abstract
NEW FINDINGS What is the central question of this study? Invasive cardiovascular instrumentation can occur through closed- or open-chest approaches. To what extent will sternotomy and pericardiotomy affect cardiopulmonary variables? What is the main finding and its importance? Opening of the thorax decreased mean systemic and pulmonary pressures. Left ventricular function improved, but no changes were observed in right ventricular systolic measures. No consensus or recommendation exists regarding instrumentation. Methodological differences risk compromising rigour and reproducibility in preclinical research. ABSTRACT Animal models of cardiovascular disease are often evaluated by invasive instrumentation for phenotyping. As no consensus exists, both open- and closed-chest approaches are used, which might compromise rigour and reproducibility in preclinical research. We aimed to quantify the cardiopulmonary changes induced by sternotomy and pericardiotomy in a large animal model. Seven pigs were anaesthetized, mechanically ventilated and evaluated by right heart catheterization and bi-ventricular pressure-volume loop recordings at baseline and after sternotomy and pericardiotomy. Data were compared by ANOVA or the Friedmann test where appropriate, with post-hoc analyses to control for multiple comparisons. Sternotomy and pericardiotomy caused reductions in mean systemic (-12 ± 11 mmHg, P = 0.027) and pulmonary pressures (-4 ± 3 mmHg, P = 0.006) and airway pressures. Cardiac output decreased non-significantly (-1329 ± 1762 ml/min, P = 0.052). Left ventricular afterload decreased, with an increase in ejection fraction (+9 ± 7%, P = 0.027) and coupling. No changes were observed in right ventricular systolic function or arterial blood gases. In conclusion, open- versus closed-chest approaches to invasive cardiovascular phenotyping cause a systematic difference in key haemodynamic variables. Researchers should adopt the most appropriate approach to ensure rigour and reproducibility in preclinical cardiovascular research.
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Affiliation(s)
- Mathilde Emilie Kirk
- Department of Clinical MedicineAarhus UniversityAarhusDenmark
- Department of CardiologyAarhus University HospitalAarhusDenmark
| | - Victor Tang Merit
- Department of Clinical MedicineAarhus UniversityAarhusDenmark
- Department of CardiologyAarhus University HospitalAarhusDenmark
| | - Niels Moeslund
- Department of Clinical MedicineAarhus UniversityAarhusDenmark
- Department of Cardiac, Lung and Vascular SurgeryAarhus University HospitalAarhusDenmark
| | - Simone Juel Dragsbaek
- Department of Clinical MedicineAarhus UniversityAarhusDenmark
- Department of CardiologyAarhus University HospitalAarhusDenmark
| | - Jacob Valentin Hansen
- Department of Clinical MedicineAarhus UniversityAarhusDenmark
- Department of CardiologyAarhus University HospitalAarhusDenmark
| | - Asger Andersen
- Department of Clinical MedicineAarhus UniversityAarhusDenmark
- Department of CardiologyAarhus University HospitalAarhusDenmark
| | - Mads Dam Lyhne
- Department of Clinical MedicineAarhus UniversityAarhusDenmark
- Department of Anaesthesiology and Intensive CareAarhus University HospitalAarhusDenmark
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Vammen L, Johannsen CM, Baltsen CD, Nørholt C, Eggertsen M, Mortensen S, Vormfenne L, Povlsen A, Donnino MW, Løfgren B, Andersen LW, Granfeldt A. Thiamine for the Treatment of Cardiac Arrest-Induced Neurological Injury: A Randomized, Blinded, Placebo-Controlled Experimental Study. J Am Heart Assoc 2023; 12:e028558. [PMID: 36942758 PMCID: PMC10122898 DOI: 10.1161/jaha.122.028558] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 02/06/2023] [Indexed: 03/23/2023]
Abstract
Background Thiamine supplementation has demonstrated protective effects in a mouse model of cardiac arrest. The aim of this study was to investigate the neuroprotective effects of thiamine in a clinically relevant large animal cardiac arrest model. The hypothesis was that thiamine reduces neurological injury evaluated by neuron-specific enolase levels. Methods and Results Pigs underwent myocardial infarction and subsequently 9 minutes of untreated cardiac arrest. Twenty minutes after successful resuscitation, the pigs were randomized to treatment with either thiamine or placebo. All pigs underwent 40 hours of intensive care and were awakened for assessment of functional neurological outcome up until 9 days after cardiac arrest. Nine pigs were included in both groups, with 8 in each group surviving the entire intensive care phase. Mean area under the curve for neuron-specific enolase was similar between groups, with 81.5 μg/L per hour (SD, 20.4) in the thiamine group and 80.5 μg/L per hour (SD, 18.3) in the placebo group, with an absolute difference of 1.0 (95% CI, -57.8 to 59.8; P=0.97). Likewise, there were no absolute difference in neurological deficit score at the end of the protocol (2 [95% CI, -38 to 42]; P=0.93). There was no absolute mean group difference in lactate during the intensive care period (1.1 mmol/L [95% CI, -0.5 to 2.7]; P=0.16). Conclusions In this randomized, blinded, placebo-controlled trial using a pig cardiac arrest model with myocardial infarction and long intensive care and observation for 9 days, thiamine showed no effect in changes to functional neurological outcome or serum levels of neuron-specific enolase. Thiamine treatment had no effect on lactate levels after successful resuscitation.
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Affiliation(s)
- Lauge Vammen
- Department of Anesthesiology and Intensive CareAarhus University HospitalAarhusDenmark
- Department of Clinical MedicineAarhus UniversityAarhusDenmark
| | - Cecilie Munch Johannsen
- Department of Anesthesiology and Intensive CareAarhus University HospitalAarhusDenmark
- Department of Clinical MedicineAarhus UniversityAarhusDenmark
| | | | - Casper Nørholt
- Department of Anesthesiology and Intensive CareAarhus University HospitalAarhusDenmark
- Department of Clinical MedicineAarhus UniversityAarhusDenmark
| | - Mark Eggertsen
- Department of Anesthesiology and Intensive CareAarhus University HospitalAarhusDenmark
- Department of Clinical MedicineAarhus UniversityAarhusDenmark
| | - Signe Mortensen
- Department of Clinical MedicineAarhus UniversityAarhusDenmark
| | - Lasse Vormfenne
- Department of Clinical MedicineAarhus UniversityAarhusDenmark
| | - Amalie Povlsen
- Department of Clinical MedicineAarhus UniversityAarhusDenmark
- Department of Cardiothoracic AnesthesiaCopenhagen University Hospital, RigshospitaletRisskovDenmark
| | - Michael W. Donnino
- Center for Resuscitation Science, Department of Emergency MedicineBeth Israel Deaconess Medical CenterBostonMAUSA
- Department of Internal Medicine, Division of PulmonaryCritical Care, and Sleep Medicine, Beth Israel Deaconess Medical CenterBostonMAUSA
| | - Bo Løfgren
- Department of Clinical MedicineAarhus UniversityAarhusDenmark
- Research Center for Emergency MedicineAarhus University HospitalAarhusDenmark
- Department of MedicineRanders Regional HospitalRandersDenmark
| | - Lars W. Andersen
- Department of Anesthesiology and Intensive CareAarhus University HospitalAarhusDenmark
- Department of Clinical MedicineAarhus UniversityAarhusDenmark
- Prehospital Emergency Medical ServicesCentral Denmark RegionAarhusDenmark
| | - Asger Granfeldt
- Department of Anesthesiology and Intensive CareAarhus University HospitalAarhusDenmark
- Department of Clinical MedicineAarhus UniversityAarhusDenmark
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Vammen L, Johannsen CM, Magnussen A, Povlsen A, Petersen SR, Azizi A, Pedersen M, Korshøj AR, Ringgaard S, Løfgren B, Andersen LW, Granfeldt A. Cerebral monitoring in a pig model of cardiac arrest with 48 h of intensive care. Intensive Care Med Exp 2022; 10:45. [PMID: 36284020 PMCID: PMC9596181 DOI: 10.1186/s40635-022-00475-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 10/17/2022] [Indexed: 11/17/2022] Open
Abstract
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 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 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 × 10–6 mm2/s [524; 765] vs 800 [799; 815], p = 0.04) and hippocampus (854 [834; 910] vs 1049 [964; 1180], p = 0.03). N-Acetylaspartate was lower on MR spectroscopy in the cardiac arrest group (− 17.2 log [− 17.4; − 17.0] vs − 16.9 [− 16.9; − 16.9], p = 0.03). 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. Supplementary Information The online version contains supplementary material available at 10.1186/s40635-022-00475-2.
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Affiliation(s)
- Lauge Vammen
- grid.154185.c0000 0004 0512 597XDepartment of Anesthesiology and Intensive Care, Aarhus University Hospital, Palle Juul Jensens Blvd. 99 G304, 8200 Aarhus N, Denmark ,grid.7048.b0000 0001 1956 2722Department of Clinical Medicine, Aarhus University, Aarhus N, Denmark
| | - Cecilie Munch Johannsen
- grid.154185.c0000 0004 0512 597XDepartment of Anesthesiology and Intensive Care, Aarhus University Hospital, Palle Juul Jensens Blvd. 99 G304, 8200 Aarhus N, Denmark ,grid.7048.b0000 0001 1956 2722Department of Clinical Medicine, Aarhus University, Aarhus N, Denmark
| | - Andreas Magnussen
- grid.7048.b0000 0001 1956 2722Department of Clinical Medicine, Aarhus University, Aarhus N, Denmark
| | - Amalie Povlsen
- grid.7048.b0000 0001 1956 2722Department of Clinical Medicine, Aarhus University, Aarhus N, Denmark ,grid.475435.4Department of Cardiothoracic Anesthesia, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Søren Riis Petersen
- grid.7048.b0000 0001 1956 2722Department of Clinical Medicine, Aarhus University, Aarhus N, Denmark
| | - Arezo Azizi
- grid.7048.b0000 0001 1956 2722Department of Clinical Medicine, Aarhus University, Aarhus N, Denmark
| | - Michael Pedersen
- grid.7048.b0000 0001 1956 2722Comparative Medicine Laboratory, Aarhus University, Aarhus N, Denmark
| | - Anders Rosendal Korshøj
- grid.7048.b0000 0001 1956 2722Department of Clinical Medicine, Aarhus University, Aarhus N, Denmark ,grid.154185.c0000 0004 0512 597XDepartment of Neurosurgery, Aarhus University Hospital, Aarhus N, Denmark
| | - Steffen Ringgaard
- grid.7048.b0000 0001 1956 2722MR Research Centre, Aarhus University, Aarhus N, Denmark
| | - Bo Løfgren
- grid.7048.b0000 0001 1956 2722Department of Clinical Medicine, Aarhus University, Aarhus N, Denmark ,grid.154185.c0000 0004 0512 597XResearch Center for Emergency Medicine, Aarhus University Hospital, Aarhus N, Denmark ,grid.415677.60000 0004 0646 8878Department of Medicine, Randers Regional Hospital, Randers, Denmark
| | - Lars W. Andersen
- grid.154185.c0000 0004 0512 597XDepartment of Anesthesiology and Intensive Care, Aarhus University Hospital, Palle Juul Jensens Blvd. 99 G304, 8200 Aarhus N, Denmark ,grid.7048.b0000 0001 1956 2722Department of Clinical Medicine, Aarhus University, Aarhus N, Denmark ,grid.425869.40000 0004 0626 6125Prehospital Emergency Medical Services, Central Denmark Region, Aarhus N, Denmark
| | - Asger Granfeldt
- grid.154185.c0000 0004 0512 597XDepartment of Anesthesiology and Intensive Care, Aarhus University Hospital, Palle Juul Jensens Blvd. 99 G304, 8200 Aarhus N, Denmark ,grid.7048.b0000 0001 1956 2722Department of Clinical Medicine, Aarhus University, Aarhus N, Denmark
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