Improving Outcomes After Post–Cardiac Arrest Brain Injury: A Scientific Statement From the International Liaison Committee on Resuscitation

医学 重症监护医学 干预(咨询) 心理干预 目标温度管理 神经保护 复苏 临床试验 自然循环恢复 心肺复苏术 精神科 急诊医学 病理 内科学
作者
Gavin D. Perkins,Robert W. Neumar,Cindy H. Hsu,Karen G. Hirsch,Anders Åneman,Lance B. Becker,Keith Couper,Clifton W. Callaway,Cornelia Hoedemaekers,Shir Lynn Lim,William J. Meurer,Theresa M. Olasveengen,Mypinder S. Sekhon,Markus B. Skrifvars,Jasmeet Soar,Min‐Shan Tsai,B Vengamma,Jerry P. Nolan
出处
期刊:Circulation [Ovid Technologies (Wolters Kluwer)]
被引量:2
标识
DOI:10.1161/cir.0000000000001219
摘要

This scientific statement presents a conceptual framework for the pathophysiology of post–cardiac arrest brain injury, explores reasons for previous failure to translate preclinical data to clinical practice, and outlines potential paths forward. Post–cardiac arrest brain injury is characterized by 4 distinct but overlapping phases: ischemic depolarization, reperfusion repolarization, dysregulation, and recovery and repair. Previous research has been challenging because of the limitations of laboratory models; heterogeneity in the patient populations enrolled; overoptimistic estimation of treatment effects leading to suboptimal sample sizes; timing and route of intervention delivery; limited or absent evidence that the intervention has engaged the mechanistic target; and heterogeneity in postresuscitation care, prognostication, and withdrawal of life-sustaining treatments. Future trials must tailor their interventions to the subset of patients most likely to benefit and deliver this intervention at the appropriate time, through the appropriate route, and at the appropriate dose. The complexity of post–cardiac arrest brain injury suggests that monotherapies are unlikely to be as successful as multimodal neuroprotective therapies. Biomarkers should be developed to identify patients with the targeted mechanism of injury, to quantify its severity, and to measure the response to therapy. Studies need to be adequately powered to detect effect sizes that are realistic and meaningful to patients, their families, and clinicians. Study designs should be optimized to accelerate the evaluation of the most promising interventions. Multidisciplinary and international collaboration will be essential to realize the goal of developing effective therapies for post–cardiac arrest brain injury.
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