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Cardiopulmonary Resuscitation in Pregnancy
Published in Afshan B. Hameed, Diana S. Wolfe, Cardio-Obstetrics, 2020
Survival is not the only outcome of interest after cardiac arrest, as survivors may experience significant morbidity. The post-cardiac arrest syndrome includes: Post-arrest brain injuryMyocardial dysfunctionIschemia-reperfusion response manifested as inflammationImpaired vascular regulationAltered coagulationTemperature dysregulationHemodynamic instabilityHyperglycemiaImmune dysfunctionMulti-organ failure [33]
Current status and prospects of IL-6–targeting therapy
Published in Expert Review of Clinical Pharmacology, 2022
Masashi Narazaki, Tadamitsu Kishimoto
IL-6 also plays a role in the pathology of acute myocardial infarction. Its level rapidly increases after myocardial infarction and is associated with worse prognosis [133]. In the first phase 2 trial of TCZ for non–ST-elevation myocardial infarction (which characteristically has elevated levels of troponin, ST depression, or T-wave inversion but no ST elevation in ECG), the median area under the curve for troponin T was lower in the intravenous TCZ group than in the placebo group [134]. This difference was observed mainly in patients included within 2 days of onset and those treated with percutaneous coronary intervention. However, in the second trial, no change in major adverse cardiac events was observed among patients who received a single dose of TCZ subcutaneously [135]. It is necessary to consider the method of TCZ administration, evaluation parameters, and selection of patients to confirm the effects of TCZ on myocardial infarction. Patients experiencing out-of-hospital cardiac arrest with comatose status after initial resuscitation are at high risk of mortality from post-cardiac arrest syndrome. Systemic inflammation is a major component of post-cardiac arrest syndrome, and IL-6 levels are associated with this syndrome severity. A phase 2 randomized trial showed that TCZ significantly reduced systemic inflammation and myocardial injury in comatose patients resuscitated from out-of-hospital cardiac arrest [136].
High platelet-lymphocyte ratio is a risk factor for 30-day mortality in in-hospital cardiac arrest patients: a case-control study
Published in Expert Review of Clinical Immunology, 2021
Lihong Huang, Jingjing Peng, Xuefeng Wang, Feng Li
A potential pathological process underlying early organ failure in IHCA patients is the development of post-cardiac arrest syndrome [5]. Four phases are thought to occur in the development of post-cardiac arrest syndrome [6], and the first two stages, which occur 0–72 h after resuscitation, are the crucial periods that determine the prognosis of patients. During this period, ischemia and hypoxia during cardiac arrest and reperfusion injury after resuscitation lead to comprehensive activation of the immune system and the coagulation pathway [7], which can lead to ‘sepsis-like syndrome’ and eventually to multiorgan dysfunction and even poor prognosis [6,8]. Sugita et al. [9] further pointed out that the inflammatory response is closely related to reperfusion injury. Prolonged hypoxia can lead to activation of endothelial cells, and comprehensive activation of multiple inflammatory pathways can lead to systemic inflammatory response syndrome, which can eventually lead to multiple organ failure and even death of patients [10]. Therefore, strengthening the monitoring of early inflammatory markers and administering targeted treatment and intervention probably improve the organ function and prognosis of patients [11–13].
Association of plasma neutrophil gelatinase-associated lipocalin with acute kidney injury and clinical outcome in cardiac arrest survivors depends on the time of measurement
Published in Biomarkers, 2018
Yong Soo Cho, Byung Kook Lee, Dong Hun Lee, Yong Hun Jung, Sung Min Lee, Jung Soo Park, Kyung Woon Jeung
Cardiac arrest leads to post-cardiac arrest syndrome characterized by multiple organ failure, even if restoration of the spontaneous circulation (ROSC) is achieved (Neumar et al.2008). Acute kidney injury (AKI) is a common organ injury following cardiac arrest, occurring in 12–49% of the patients (Mattana and Singhal 1993, Domanovits et al.2001, Geri et al.2015, Tujjar et al.2015, Beitland et al. 2016). AKI is a well-known independent risk factor for mortality in critically ill patients, and several recent studies including cardiac arrest survivors reported that AKI was associated with increased in-hospital mortality (Vaara et al.2014, Geri et al.2015, Tujjar et al.2015, Beitland et al. 2016). It remains inconclusive whether early renal replacement therapy (RRT) can reduce mortality in critically ill patients with AKI (Matsa et al.2014, Zarbock et al.2016). However, RRT is generally indicated for AKI above stage 2 (high stage AKI) according to the Kidney Disease Improving Global Outcomes (KDIGO) guidelines; patients with AKI after cardiac arrest are also treated with RRT in many hospitals (KDIGO 2012, Yanta et al.2013, Geri et al.2015, Tujjar et al.2015). Therefore, diagnosis of high stage AKI patients who are indicated for RRT during post-cardiac arrest care is required to enhance resuscitative care.