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Monitoring the Brain After Cardiac Arrest: a New Era

  • Niraj SinhaEmail author
  • Sam Parnia
Critical Care (S Mayer, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Critical Care

Abstract

Purpose of Review

Of the approximately 350,000 out-of-hospital, and 750,000 after in-hospital cardiac arrest (CA) events in the US annually approximately 5-9% and 20% respectively may achieve return of spontaneous circulation (ROSC) after attempted cardiopulmonary resuscitation (CPR). Up to 2/3 of these initial survivors may go on die in the subsequent 24-72 hours after ROSC due to a combination of (1) on-going cerebral injury, (2) myocardial dysfunction and (3) massive systemic inflammatory response. In order to successfully manage patients more effectively, monitoring methods are needed to aid clinicians in the detection and quantification of intra-cardiac arrest and post-resuscitation pathophysiological cerebral injury processes in the intensive care unit.

Recent Findings

Over the last few years many modalities have been used for cerebral monitoring during and after CA, these include quantitative pupillometry, transcranial doppler sonography, optic nerve sheath diameter measurements, microdialysis, tissue oxygenation monitoring, intra-cranial pressure monitoring, and electroencephalography. Current studies indicate that these modalities may be used for the purpose of neurological monitoring during cardiac arrest resuscitation as well as in the post-resuscitation period.

Summary

Multiple overlapping processes, including alterations in cerebral blood flow (CBF), raised intracerebralpressure, disorders of metabolism, imbalanced oxygen delivery and reperfusion injury contribute to cell death during the post-resuscitation period has led to the birth of post-resuscitation management strategies in the 21st century. This review provides a succinct overview of currently available bedside invasive and non-invasive neuro-monitoring methods after CA.

Keywords

Cardiac arrest Post-resuscitation Cerebral oximetry Cerebral perfusion Near-infrared spectroscopy (NIRS) Cerebral blood flow 

Notes

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflicts of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

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Authors and Affiliations

  1. 1.Resuscitation Research Group, Division of Pulmonary and Critical Care Medicine, Department of Medicine, Stony Brook University Medical CenterState University of New York at Stony BrookStony BrookUSA
  2. 2.Division of Pulmonary, Critical Care and Sleep Medicine, Department of MedicineNew York University Langone Medical CenterNew YorkUSA

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