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Cerebral Edema After Cardiopulmonary Resuscitation: A Therapeutic Target Following Cardiac Arrest?

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Abstract

We sought to review the role that cerebral edema plays in neurologic outcome following cardiac arrest, to understand whether cerebral edema might be an appropriate therapeutic target for neuroprotection in patients who survive cardiopulmonary resuscitation. Articles indexed in PubMed and written in English. Following cardiac arrest, cerebral edema is a cardinal feature of brain injury and is a powerful prognosticator of neurologic outcome. Like other conditions characterized by cerebral ischemia/reperfusion, neuroprotection after cardiac arrest has proven to be difficult to achieve. Neuroprotection after cardiac arrest generally has focused on protecting neurons, not the microvascular endothelium or blood–brain barrier. Limited preclinical data suggest that strategies to reduce cerebral edema may improve neurologic outcome. Ongoing research will be necessary to determine whether targeting cerebral edema will improve patient outcomes after cardiac arrest.

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Acknowledgements

This work was supported by grants to JMS from the National Institute of Neurological Disorders and Stroke (NS060801; NS061808) and the National Heart, Lung, and Blood Institute (HL082517). We are grateful to Aaron Wessell, M.D., for his artistry, depicted in Fig. 1.

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  1. Department of Neurosurgery, University of Maryland School of Medicine, 22 S. Greene St., Suite S12D, Baltimore, MD, 21201-1595, USA

    Erik G. Hayman, Akil P. Patel & J. Marc Simard

  2. Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA

    W. Taylor Kimberly

  3. Division of Neurocritical Care, Department of Neurology, Yale University School of Medicine, New Haven, CT, USA

    Kevin N. Sheth

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  1. Erik G. Hayman
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Correspondence to J. Marc Simard.

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Conflict of interest

JMS holds a US patent (#7,285,574), “A novel non-selective cation channel in neural cells and methods for treating brain swelling,” and is a member of the scientific advisory board and holds shares in Remedy Pharmaceuticals. WTK and KNS received grants from Remedy Pharmaceuticals.

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Hayman, E.G., Patel, A.P., Kimberly, W.T. et al. Cerebral Edema After Cardiopulmonary Resuscitation: A Therapeutic Target Following Cardiac Arrest?. Neurocrit Care 28, 276–287 (2018). https://doi.org/10.1007/s12028-017-0474-8

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