TY - JOUR
T1 - The future is now
T2 - Neuroprotection during cardiopulmonary resuscitation
AU - Moore, Johanna C
AU - Bartos, Jason A.
AU - Matsuura, Timothy R.
AU - Yannopoulos, Demetris
PY - 2017
Y1 - 2017
N2 - Purpose of review Survival with favorable neurological function after cardiac arrest remains low. The purpose of this review is to identify recent advances that focus on neuroprotection during cardiopulmonary resuscitation (CPR). Recent findings Multiple strategies have been shown to enhance neuroprotection during CPR. Brain perfusion during CPR is increased with therapies such as active compression decompression CPR and intrathoracic pressure regulation that improve cardiac preload and decrease intracranial pressure. Head Up CPR has been shown to decrease intracranial pressure thereby increasing cerebral perfusion pressure and cerebral blood flow. Sodium nitroprusside enhanced CPR increases cerebral perfusion, facilitates heat exchange, and improves neurologic survival in swine after cardiac arrest. Postconditioning has been administered during CPR in laboratory settings. Poloxamer 188, a membrane stabilizer, and ischemic postconditioning have been shown to improve cardiac and neural function after cardiac arrest in animal models. Postconditioning with inhaled gases protects the myocardium, with more evidence mounting for the potential for neural protection. Summary Multiple promising neuroprotective therapies are being developed in animal models of cardiac arrest, and are in early stages of human trials. These therapies have the potential to be bundled together to improve rates of favorable neurological survival after cardiac arrest.
AB - Purpose of review Survival with favorable neurological function after cardiac arrest remains low. The purpose of this review is to identify recent advances that focus on neuroprotection during cardiopulmonary resuscitation (CPR). Recent findings Multiple strategies have been shown to enhance neuroprotection during CPR. Brain perfusion during CPR is increased with therapies such as active compression decompression CPR and intrathoracic pressure regulation that improve cardiac preload and decrease intracranial pressure. Head Up CPR has been shown to decrease intracranial pressure thereby increasing cerebral perfusion pressure and cerebral blood flow. Sodium nitroprusside enhanced CPR increases cerebral perfusion, facilitates heat exchange, and improves neurologic survival in swine after cardiac arrest. Postconditioning has been administered during CPR in laboratory settings. Poloxamer 188, a membrane stabilizer, and ischemic postconditioning have been shown to improve cardiac and neural function after cardiac arrest in animal models. Postconditioning with inhaled gases protects the myocardium, with more evidence mounting for the potential for neural protection. Summary Multiple promising neuroprotective therapies are being developed in animal models of cardiac arrest, and are in early stages of human trials. These therapies have the potential to be bundled together to improve rates of favorable neurological survival after cardiac arrest.
KW - Active compression decompression CPR
KW - Cardiopulmonary resuscitation
KW - Head Up CPR
KW - Inhaled anesthetics
KW - Intrathoracic pressure regulation
KW - Ischemic postconditioning
KW - Poloxamer 188
KW - SNPeCPR
UR - http://www.scopus.com/inward/record.url?scp=85016096235&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85016096235&partnerID=8YFLogxK
U2 - 10.1097/MCC.0000000000000405
DO - 10.1097/MCC.0000000000000405
M3 - Review article
C2 - 28346232
AN - SCOPUS:85016096235
SN - 1070-5295
VL - 23
SP - 215
EP - 222
JO - Current opinion in critical care
JF - Current opinion in critical care
IS - 3
ER -