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Dietrich M, Weilbacher F, Katzenschlager S, Weigand MA, Popp E. Severe trauma associated cardiac failure. Scand J Trauma Resusc Emerg Med 2024; 32:4. [PMID: 38254167 PMCID: PMC10804718 DOI: 10.1186/s13049-024-01175-4] [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: 01/07/2024] [Accepted: 01/08/2024] [Indexed: 01/24/2024] Open
Abstract
Although significant efforts have been made to enhance trauma care, the mortality rate for traumatic cardiac arrest (TCA) remains exceedingly high. Therefore, our institution has implemented special measures to optimize the treatment of major trauma patients. These measures include a prehospital Medical Intervention Car (MIC) and a 'code red' protocol in the trauma resuscitation room for patients with TCA or shock. These measures enable the early treatment of reversible causes of TCA and have resulted in a significant number of patients achieving adequate ROSC. However, a significant proportion of these patients still die due to circulatory failure shortly after. Our observations from patients who underwent clamshell thoracotomy or received echocardiographic evaluation in conjunction with current scientific findings led us to conclude that dysfunction of the heart itself may be the cause. Therefore, we propose discussing severe trauma-associated cardiac failure (STAC) as a new entity to facilitate scientific research and the development of specific treatment strategies, with the aim of improving the outcome of severe trauma.
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Affiliation(s)
- Maximilian Dietrich
- Medical Faculty Heidelberg, Department of Anesthesiology, Heidelberg University, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany.
| | - Frank Weilbacher
- Medical Faculty Heidelberg, Department of Anesthesiology, Heidelberg University, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany
| | - Stephan Katzenschlager
- Medical Faculty Heidelberg, Department of Anesthesiology, Heidelberg University, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany
| | - Markus A Weigand
- Medical Faculty Heidelberg, Department of Anesthesiology, Heidelberg University, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany
| | - Erik Popp
- Medical Faculty Heidelberg, Department of Anesthesiology, Heidelberg University, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany
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Salvas JP, Leyba KA, Schepers LE, Paiyabhroma N, Goergen CJ, Sicard P. Neurovascular Hypoxia Trajectories Assessed by Photoacoustic Imaging in a Murine Model of Cardiac Arrest and Resuscitation. IEEE TRANSACTIONS ON ULTRASONICS, FERROELECTRICS, AND FREQUENCY CONTROL 2023; 70:1661-1670. [PMID: 37043326 DOI: 10.1109/tuffc.2023.3265800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Cardiac arrest is a common cause of death annually mainly due to postcardiac arrest syndrome that leads to multiple organ global hypoxia and dysfunction after resuscitation. The ability to quantify vasculature changes and tissue oxygenation is crucial to adapt patient treatment in order to minimize major outcomes after resuscitation. For the first time, we applied high-resolution ultrasound associated with photoacoustic imaging (PAI) to track neurovascular oxygenation and cardiac function trajectories in a murine model of cardiac arrest and resuscitation. We report the preservation of brain oxygenation is greater compared to that in peripheral tissues during the arrest. Furthermore, distinct patterns of cerebral oxygen decay may relate to the support of vital brain functions. In addition, we followed trajectories of cerebral perfusion and cardiac function longitudinally after induced cardiac arrest and resuscitation. Volumetric cerebral oxygen saturation (sO2) decreased 24 h postarrest, but these levels rebounded at one week. However, systolic and diastolic cardiac dysfunction persisted throughout and correlated with cerebral hypoxia. Pathophysiologic biomarker trends, identified via cerebral PAI in preclinical models, could provide new insights into understanding the pathophysiology of cardiac arrest and resuscitation.
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CAVALIERE F, BIANCOFIORE G, BIGNAMI E, DE ROBERTIS E, GIANNINI A, GRASSO S, PIASTRA M, SCOLLETTA S, TACCONE FS, TERRAGNI P. A year in review in Minerva Anestesiologica 2021. Critical care. Minerva Anestesiol 2022; 88:89-100. [DOI: 10.23736/s0375-9393.21.16409-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Liang L, Zhang G, Cheng C, Li H, Jin T, Su C, Xiao Y, Bradley J, Peberdy MA, Ornato JP, Mangino MJ, Tang W. High-resolution respirometry for evaluation of mitochondrial function on brain and heart homogenates in a rat model of cardiac arrest and cardiopulmonary resuscitation. Biomed Pharmacother 2021; 142:111935. [PMID: 34467895 DOI: 10.1016/j.biopha.2021.111935] [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: 12/10/2020] [Revised: 07/12/2021] [Accepted: 07/14/2021] [Indexed: 10/20/2022] Open
Abstract
The physiology and physiopathology process of mitochondrial function following cardiac arrest remains poorly understood. We aimed to assess mitochondrial respiratory function on the heart and brain homogenates from cardiac arrest rats. The expression level of SIRT1/PGC-1α pathway was measured by immunoblotting. 30 rats were assigned to the CA group and the sham group. Rats of CA were subjected to 6 min of untreated ventricular fibrillation (VF) followed by 8 min of cardiopulmonary resuscitation (CPR). Mitochondrial respiratory function was compromised following CA and I/R injury, as indicated by CIL (451.46 ± 71.48 vs. 909.91 ± 5.51 pmol/min*mg for the heart and 464.14 ± 8.22 vs. 570.53 ± 56.33 pmol/min*mg for the brain), CI (564.04 ± 64.34 vs. 2729.52 ± 347.39 pmol/min*mg for the heart and 726.07 ± 85.78 vs. 1762.82 ± 262.04 pmol/min*mg for the brain), RCR (1.88 ± 0.46 vs. 3.57 ± 0.38 for the heart and 2.05 ± 0.19 vs. 3.49 ± 0.19, for the brain) and OXPHOS coupling efficiency (0.45 ± 0.11 vs. 0.72 ± 0.03 for the heart and 0.52 ± 0.05 vs. 0.71 ± 0.01 for the brain). However, routine respiration was lower in the heart and comparable in the brain after CA. CIV did not change in the heart but was enhanced in the brain. Furthermore, both SIRT1 and PGC-1α were downregulated concurrently in the heart and brain. The mitochondrial respiratory function was compromised following CA and I/R injury, and the major affected respiratory state is complex I-linked respiration. Furthermore, the heart and the brain respond differently to the global I/R injury after CA in mitochondrial respiratory function. Inhibition of the SIRT1/PGC-1α pathway may be a major contributor to the impaired mitochondrial respiratory function.
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Affiliation(s)
- Lian Liang
- Department of Emergency, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China; Weil Institute of Emergency and Critical Care Research, Virginia Commonwealth University, Richmond, VA, USA; Institute of Cardiopulmonary Cerebral Resuscitation, Sun Yat-Sen University, Guangzhou, China
| | - Guozhen Zhang
- Weil Institute of Emergency and Critical Care Research, Virginia Commonwealth University, Richmond, VA, USA; Department of Intensive Care Medicine, Tianjin Cancer Hospital Airport Free Trade Zone Hospital, Tianjin, China
| | - Cheng Cheng
- Weil Institute of Emergency and Critical Care Research, Virginia Commonwealth University, Richmond, VA, USA; Department of Intensive Care Medicine, The Second Hospital of Anhui Medical University, Hefei, China
| | - Hui Li
- Weil Institute of Emergency and Critical Care Research, Virginia Commonwealth University, Richmond, VA, USA; Department of Intensive Care Medicine, The Second Hospital of Anhui Medical University, Hefei, China
| | - Tao Jin
- Weil Institute of Emergency and Critical Care Research, Virginia Commonwealth University, Richmond, VA, USA
| | - Chenglei Su
- Weil Institute of Emergency and Critical Care Research, Virginia Commonwealth University, Richmond, VA, USA
| | - Yan Xiao
- Weil Institute of Emergency and Critical Care Research, Virginia Commonwealth University, Richmond, VA, USA
| | - Jennifer Bradley
- Weil Institute of Emergency and Critical Care Research, Virginia Commonwealth University, Richmond, VA, USA
| | - Mary A Peberdy
- Weil Institute of Emergency and Critical Care Research, Virginia Commonwealth University, Richmond, VA, USA; Department of Internal Medicine and Emergency Medicine, Virginia Commonwealth University Health System, Richmond, VA, USA
| | - Joseph P Ornato
- Weil Institute of Emergency and Critical Care Research, Virginia Commonwealth University, Richmond, VA, USA; Department of Emergency Medicine, Virginia Commonwealth University Health System, Richmond, VA, USA
| | - Martin J Mangino
- Weil Institute of Emergency and Critical Care Research, Virginia Commonwealth University, Richmond, VA, USA; Department of Surgery, Virginia Commonwealth University Health System, Richmond, VA, USA
| | - Wanchun Tang
- Weil Institute of Emergency and Critical Care Research, Virginia Commonwealth University, Richmond, VA, USA; Department of Emergency Medicine, Virginia Commonwealth University Health System, Richmond, VA, USA.
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