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MgSO4 infusion combined with therapeutic hypothermia in the post-resuscitation phase confers cerebral neuroprotection via complementary protective mechanisms
Abstracts / Resuscitation 96S (2015) 43–157
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trend toward higher frequency of Gram-negative bacteria in OHCA patients compared to IHCA (22% vs 12%; p = 0.08). There was no difference in the rate of fungal infection between OHCA and IHCA (15% vs 14%; p = 0.8). Conclusion: Approximately one third of post-arrest patients had pathogenic respiratory microorganisms in the early post-arrest period. The most common isolates were Gram-negative bacteria. Overall, there is no difference in the prevalence in culture positive results between OHCA and IHCA.
combination group, suggesting that combination therapy provides best neuroprotection. Conclusions: MgSO4 infusion combined with TH in the postresuscitation phase exhibits additional cerebral neuroprotection compared to TH alone. Such protection is in part conferred by complementary protective mechanisms.
http://dx.doi.org/10.1016/j.resuscitation.2015.09.320 AP224
The influence of post-rewarming temperature management on the development of post-hypothermia fever after cardiac arrest
MgSO4 infusion combined with therapeutic hypothermia in the post-resuscitation phase confers cerebral neuroprotection via complementary protective mechanisms
Byung Kook Lee ∗ , Kyung Woon Jeung, Dong Hun Lee, Kyoung Hwan Song, Yong Hun Jung, Sung Min Lee, Yong Soo Cho
Wei-Tien Chang 1,∗ , Chien-Hsiang Huang 2 , Woan-Yi Wang 1 , Hsiao-Ching Wei 1 , Chun-Pei Lee 1 , Hooi-Nee Ong 1 , Chien-Hua Huang 1 , Min-Shan Tsai 1 , Chih-Hung Wang 1 , Ping-Hsun Yu 3 , An-Yi Wang 1 , Hsiao-Ju Cheng 1 , Chiao-Chi Chen 2 , Chen Chang 2 , Wen-Jone Chen 1
Chonnam National University, Gwangju, Republic of Korea
1 Department of Emergency Medicine, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan 2 Institute of Biomedical Science, Academia Sinica, Taipei, Taiwan 3 Department of Emergency Medicine, Taipei Hospital, Ministry of Health and Welfare, New Taipei City, Taiwan
Purpose: To explore the neuroprotective effect and protective mechanisms when combining MgSO4 infusion with therapeutic hypothermia (TH) after CPR. Materials and methods: Using a rat model of cardiac arrest and CPR, we employed TH (32 ◦ C, 2 h) and MgSO4 infusion (50 mg/kg/h, 3.5 h) individually or in combination in the post-resuscitation phase. Cerebral tissue perfusion was measured by OxyFlo. Blood was sampled 4 h post-CPR for measurement of reactive oxygen species (ROS) and nitrate/nitrite (indicator of nitric oxide, NO). Brain was harvested 4 h post-CPR for measurement of malondialdehyde and phosphorylated eNOS. In a subgroup MR imaging was employed for demonstration of cerebral vasculature using time-offlight MR angiography (TOF-MRA). Apparent diffusion coefficient (ADC) was used to determine vasogenic edema, and dynamic contrast-enhanced MRI (DCE-MRI) was employed for measurement of blood-brain-barrier disruption. MR spectroscopy was done for measurement of cerebral metabolites. Results: Compared to standard post-CPR care control, TH showed reduction of ROS generation (both systemic and in brain), ADC and blood-brain-barrier disruption in the post-resuscitation phase, but no amelioration of cerebral vasoconstriction or tissue perfusion. In contrast, MgSO4 significantly improved cerebral vasoconstriction, tissue perfusion and blood-brain-barrier disruption, but not ADC. NO generation and phosphorylated eNOS were significantly increased in MgSO4 but much less in TH, an effect consistent with that seen on TOF-MRA and tissue perfusion. For combination therapy, the effects on ADC and DCE-MRI were as good as in TH. Phosphorylated eNOS, NO, TOF-MRA and tissue perfusion were improved, but the effects were less as compared to MgSO4 group. Most importantly, the neuronal viability as indicated by N-acetylaspartate on MR spectroscopy was best preserved in the
http://dx.doi.org/10.1016/j.resuscitation.2015.09.321 AP225
Purpose: Hyperthermia following cardiac arrest leads to poor outcomes in cardiac arrest survivors treated without therapeutic hypothermia (TH). However, the association between post-hypothermia fever (PHF) and clinical outcome in patients treated with TH is still controversial. Our institute implemented post-rewarming temperature management (PRTM) to inhibit the development of PHF. The aim of this study was to examine the association between PRTM and PHF and to determine the associations between in-hospital mortality and PHF, the highest temperature during the post-rewarming phase, and the mean temperature during the post-rewarming phase. Methods: This retrospective observational study included consecutive adult cardiac arrest survivors treated with TH from 2008 to 2013. The population was stratified into two groups by implementation of PRTM. PHF was defined as temperature over 38 ◦ C within 48 h after rewarming. The primary outcome was PHF, and the secondary outcome was in-hospital mortality. Results: Of 277 included patients, 29.2% had PHF. PRTM was not associated with the development of PHF (OR 0.963, CI 0.519, 1.787). Younger age (OR 0.928, CI 0.966, 1.000), cardiac etiology (OR 2.100, CI 1.159, 3.803), and lower sequential organ failure assessment (SOFA) score (OR 0.808, CI 0.726, 0.898) were associated with development of PHF. In-hospital mortality was 29.4%. PHF (OR 0.243, CI 0.110, 0.534) was associated with survival to hospital discharge. The highest temperature (OR 0.440, CI 0.293, 0.661) and the mean temperature (OR 0.099, CI 0.037, 0.262) during the 48 h of the postrewarming phase were also associated with survival to discharge. Conclusion: PRTM is not associated with the development of PHF. Younger age, cardiac etiology, and lower SOFA scores are associated with the development of PHF. PHF is associated with survival to hospital discharge. Higher body temperature during the 48 h after rewarming is also associated with survival to discharge. http://dx.doi.org/10.1016/j.resuscitation.2015.09.322
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trend toward higher frequency of Gram-negative bacteria in OHCA patients compared to IHCA (22% vs 12%; p = 0.08). There was no difference in the rate of fungal infection between OHCA and IHCA (15% vs 14%; p = 0.8). Conclusion: Approximately one third of post-arrest patients had pathogenic respiratory microorganisms in the early post-arrest period. The most common isolates were Gram-negative bacteria. Overall, there is no difference in the prevalence in culture positive results between OHCA and IHCA.
combination group, suggesting that combination therapy provides best neuroprotection. Conclusions: MgSO4 infusion combined with TH in the postresuscitation phase exhibits additional cerebral neuroprotection compared to TH alone. Such protection is in part conferred by complementary protective mechanisms.
http://dx.doi.org/10.1016/j.resuscitation.2015.09.320 AP224
The influence of post-rewarming temperature management on the development of post-hypothermia fever after cardiac arrest
MgSO4 infusion combined with therapeutic hypothermia in the post-resuscitation phase confers cerebral neuroprotection via complementary protective mechanisms
Byung Kook Lee ∗ , Kyung Woon Jeung, Dong Hun Lee, Kyoung Hwan Song, Yong Hun Jung, Sung Min Lee, Yong Soo Cho
Wei-Tien Chang 1,∗ , Chien-Hsiang Huang 2 , Woan-Yi Wang 1 , Hsiao-Ching Wei 1 , Chun-Pei Lee 1 , Hooi-Nee Ong 1 , Chien-Hua Huang 1 , Min-Shan Tsai 1 , Chih-Hung Wang 1 , Ping-Hsun Yu 3 , An-Yi Wang 1 , Hsiao-Ju Cheng 1 , Chiao-Chi Chen 2 , Chen Chang 2 , Wen-Jone Chen 1
Chonnam National University, Gwangju, Republic of Korea
1 Department of Emergency Medicine, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan 2 Institute of Biomedical Science, Academia Sinica, Taipei, Taiwan 3 Department of Emergency Medicine, Taipei Hospital, Ministry of Health and Welfare, New Taipei City, Taiwan
Purpose: To explore the neuroprotective effect and protective mechanisms when combining MgSO4 infusion with therapeutic hypothermia (TH) after CPR. Materials and methods: Using a rat model of cardiac arrest and CPR, we employed TH (32 ◦ C, 2 h) and MgSO4 infusion (50 mg/kg/h, 3.5 h) individually or in combination in the post-resuscitation phase. Cerebral tissue perfusion was measured by OxyFlo. Blood was sampled 4 h post-CPR for measurement of reactive oxygen species (ROS) and nitrate/nitrite (indicator of nitric oxide, NO). Brain was harvested 4 h post-CPR for measurement of malondialdehyde and phosphorylated eNOS. In a subgroup MR imaging was employed for demonstration of cerebral vasculature using time-offlight MR angiography (TOF-MRA). Apparent diffusion coefficient (ADC) was used to determine vasogenic edema, and dynamic contrast-enhanced MRI (DCE-MRI) was employed for measurement of blood-brain-barrier disruption. MR spectroscopy was done for measurement of cerebral metabolites. Results: Compared to standard post-CPR care control, TH showed reduction of ROS generation (both systemic and in brain), ADC and blood-brain-barrier disruption in the post-resuscitation phase, but no amelioration of cerebral vasoconstriction or tissue perfusion. In contrast, MgSO4 significantly improved cerebral vasoconstriction, tissue perfusion and blood-brain-barrier disruption, but not ADC. NO generation and phosphorylated eNOS were significantly increased in MgSO4 but much less in TH, an effect consistent with that seen on TOF-MRA and tissue perfusion. For combination therapy, the effects on ADC and DCE-MRI were as good as in TH. Phosphorylated eNOS, NO, TOF-MRA and tissue perfusion were improved, but the effects were less as compared to MgSO4 group. Most importantly, the neuronal viability as indicated by N-acetylaspartate on MR spectroscopy was best preserved in the
http://dx.doi.org/10.1016/j.resuscitation.2015.09.321 AP225
Purpose: Hyperthermia following cardiac arrest leads to poor outcomes in cardiac arrest survivors treated without therapeutic hypothermia (TH). However, the association between post-hypothermia fever (PHF) and clinical outcome in patients treated with TH is still controversial. Our institute implemented post-rewarming temperature management (PRTM) to inhibit the development of PHF. The aim of this study was to examine the association between PRTM and PHF and to determine the associations between in-hospital mortality and PHF, the highest temperature during the post-rewarming phase, and the mean temperature during the post-rewarming phase. Methods: This retrospective observational study included consecutive adult cardiac arrest survivors treated with TH from 2008 to 2013. The population was stratified into two groups by implementation of PRTM. PHF was defined as temperature over 38 ◦ C within 48 h after rewarming. The primary outcome was PHF, and the secondary outcome was in-hospital mortality. Results: Of 277 included patients, 29.2% had PHF. PRTM was not associated with the development of PHF (OR 0.963, CI 0.519, 1.787). Younger age (OR 0.928, CI 0.966, 1.000), cardiac etiology (OR 2.100, CI 1.159, 3.803), and lower sequential organ failure assessment (SOFA) score (OR 0.808, CI 0.726, 0.898) were associated with development of PHF. In-hospital mortality was 29.4%. PHF (OR 0.243, CI 0.110, 0.534) was associated with survival to hospital discharge. The highest temperature (OR 0.440, CI 0.293, 0.661) and the mean temperature (OR 0.099, CI 0.037, 0.262) during the 48 h of the postrewarming phase were also associated with survival to discharge. Conclusion: PRTM is not associated with the development of PHF. Younger age, cardiac etiology, and lower SOFA scores are associated with the development of PHF. PHF is associated with survival to hospital discharge. Higher body temperature during the 48 h after rewarming is also associated with survival to discharge. http://dx.doi.org/10.1016/j.resuscitation.2015.09.322