A case of thyroid emergency with cardiac arrest supported by extracorporeal membrane oxygenation

Inhibition of microRNA-155 Alleviates Neurological Dysfunction Following Transient Global Ischemia and Contribution of Neuroinflammation and Oxidative Stress in the Hippocampus

BACKGROUND/AIMS

Central pro-inflammatory cytokine (PIC) signal is involved in neurological deficits after transient global ischemia induced by cardiac arrest (CA). The present study was to examine the role of microRNA- 155 (miR-155) in regulating IL-1β, IL-6 and TNF-α in the hippocampus of rats with induction of CA. We further examined the levels of products of oxidative stress 8-isoprostaglandin F2α (8-iso PGF2α, indication of oxidative stress); and 8-hydroxy-2'-deoxyguanosine (8-OHdG, indication of protein oxidation) after cerebral inhibition of miR-155.

METHODS

CA was induced by asphyxia and followed by cardiopulmonary resuscitation in rats. ELISA and western blot analysis were used to determine the levels of PICs and products of oxidative stress; and the protein expression of NADPH oxidase (NOXs) in the hippocampus. In addition, neurological severity score and brain edema were examined to assess neurological functions.

RESULTS

We observed amplification of IL-1β, IL-6 and TNF-α along with 8-iso PGF2α and 8-OHdG in the hippocampus of CA rats. Cerebral administration of miR-155 inhibitor diminished upregulation of PICs in the hippocampus. This also attenuated products of oxidative stress and upregulation of NOX4. Notably, inhibition of miR-155 improved neurological severity score and brain edema and this was linked to signal pathways of PIC and oxidative stress.

CONCLUSION

We showed the significant role of blocking miR-155 signal in improving the neurological function in CA rats likely via inhibition of signal pathways of neuroinflammation and oxidative stress, suggesting that miR-155 may be a target in preventing and/or alleviating development of the impaired neurological functions during CA-evoked global cerebral ischemia.

Changes in peak inspiratory flow rate and peak airway pressure with endotracheal tube size during chest compression

BACKGROUND

Adequate airway management plays an important role in high-quality cardiopulmonary resuscitation (CPR). Airway management is usually performed using an endotracheal tube (ETT) during CPR. However, no study has assessed the effect of ETT size on the flow rate and airway pressure during CPR.

METHODS

We measured changes in peak inspiratory flow rate (PIFR), peak airway pressure (P_peak), and mean airway pressure (P_mean) according to changes in ETT size (internal diameter 6.0, 7.0, and 8.0 mm) and with or without CPR. A tidal volume of 500 mL was supplied at a rate of 10 times per minute using a mechanical ventilator. Chest compressions were maintained at a constant compression depth and speed using a mechanical chest compression device (LUCAS2, mode: active continuous, chest compression rate: 102±2/minute, chest compression depth 2-2.5 inches).

RESULTS

The median of several respiratory physiological parameters during CPR was significantly different according to the diameter of each ETT (6.0 vs. 8.0 mm): PIFR (32.1 L/min [30.5-35.3] vs. 28.9 L/min [27.5-30.8], P<0.001), P_peak (48.84 cmH₂O [27.46-52.11] vs. 27.45 cmH₂O [22.53-52.57], P<0.001), and P_mean (18.34 cmH₂O [14.61-21.66] vs.13.66 cmH₂O [8.41-19.24], P<0.001).

CONCLUSION

The changes in PIFR, P_peak, and P_mean were related to the internal diameter of ETT, and these values tended to decrease with an increase in ETT size. Higher airway pressures were measured in the CPR group than in the no CPR group.