A systematic review of neuroprotective strategies after cardiac arrest: From bench to bedside (part II-comprehensive protection)

Lei Huang, Patricia Applegate, Jason W. Gatling, Dustin B. Mangus, John Zhang, Richard Lee Applegate

Research output: Contribution to journalReview article

23 Scopus citations

Abstract

Neurocognitive deficits remain a significant source of morbidity in survivors of cardiac arrest. We conducted a literature review of treatment protocols designed to evaluate neurologic outcome and survival following global cerebral ischemia associated with cardiac arrest. The search was limited to investigational therapies that were implemented either during cardiopulmonary resuscitation or after return of spontaneous circulation in studies that included assessment of impact on neurologic outcome. Given that complex pathophysiology underlies global brain hypoxic ischemia following cardiac arrest, neuroprotective strategies targeting multiple stages of neuropathologic cascades should promise to improve survival and neurologic outcomes in cardiac arrest victims. In Part II of this review, we discuss several approaches that can provide comprehensive protection against global brain injury associated with cardiac arrest, by modulating multiple targets of neuropathologic cascades. Pharmaceutical approaches include adenosine and growth factors/hormones including brain-derived neurotrophic factor, insulin-like growth factor-1 and glycine-proline-glutamate, granulocyte colony stimulating factor and estrogen. Preclinical studies of these showed some benefit but were inconclusive in models of global brain injury involving systemic ischemia. Several medical gases that can mediate neuroprotection have been evaluated in experimental settings. These include hydrogen sulfide, hyperbaric oxygen and molecular hydrogen. Hyperbaric oxygen and molecular hydrogen showed promising results; however, further investigation is required prior to clinical application of these agents in cardiac arrest patients.

Original languageEnglish (US)
Article number10
JournalMedical Gas Research
Volume4
Issue number1
DOIs
StatePublished - May 20 2014
Externally publishedYes

Keywords

  • Cardiac arrest
  • Comprehensive neuroprotection
  • Global brain injury
  • Hydrogen gas
  • Hydrogen sulfide
  • Hyperbaric oxygen
  • Model
  • Pharmaceutical

ASJC Scopus subject areas

  • Neuroscience (miscellaneous)
  • Anesthesiology and Pain Medicine

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