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Efficacy of Citicoline as a Neuroprotector in children with post cardiac arrest: a randomized controlled clinical trial

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Abstract

Brain hypoxia after cardiac arrest leads to damage of the neuronal cell membrane. Citicoline is necessary for the synthesis of cell membrane. We planned to assess the neuroprotective effect of citicoline in children after cardiac arrest. This randomized controlled trial was carried out at pediatric intensive care units (PICU) and surgical ICU at Tanta university hospital on 80 consecutive children surviving in-hospital cardiac arrest who were subdivided into two groups. Group I (citicoline group) included 40 children with post-cardiac arrest who received citicoline 10 mg /kg /12 h IV for 6 weeks plus other supportive measures and group II (control group) included 40 children with post-cardiac arrest who were managed with only supportive measures. All patients were evaluated for Glasgow coma score (GCS), modified Rankin scale (mRS) for children, seizures frequency, type and duration, and serum neuron-specific enolase (NSE) before and 3 months after the treatment. GCS and mRS significantly improved in citicholine group compared to the control group. Seizure frequency and duration, mortality, PICU and hospital stay significantly decreased in citicholine group compared to the control group. Serum NSE levels significantly decreased in citicholine group only. No side effects were recorded.

Conclusion: Citicoline is a promising neuroprotective drug in children with post-cardiac arrest.

Trial Registration: The study was registered at Pan African Clinical Trials Registry (PACTR) www.pactr.samrc.ac.za with trial number PACTR201907742119058.

What is known?

• Post-resuscitation brain injury is one of the major complications that can lead to death or disability.

• CDP-choline has been studied for acute ischemic stroke in several adult studies because of its reparative effect.

What is new?

• Our study was the first in pediatrics that assessed the neuroprotective effect of CDP-choline on the brain in children after cardiac arrest.

• We found that Citicoline is a promising neuroprotective drug in children with post-cardiac arrest.

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List of abbreviations

ELISA enzyme linked immunosorbent assay.

GCS Glasgow coma scale.

ICU intensive care unit.

mRS modified Rankin Scale.

NSE neuron-specific enolase.

PACTR Pan African Clinical Trials Registry.

PALS pediatric advanced life support.

PICU pediatric intensive care unit.

PRISM III pediatric risk of mortality 3.

SD standard deviation.

Author information

Authors and Affiliations

  1. Pediatric Department, Kafr Elsheikh University, Kafr Elsheikh, Egypt

    Abeer Salamah

  2. Pediatric Department, Tanta University, Tanta, Egypt

    Mostafa Mehrez & Doaa El Amrousy

  3. Anesthesiology and Surgical ICU Department, Tanta University, Tanta, Egypt

    Amany Faheem

Authors
  1. Abeer Salamah
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  2. Mostafa Mehrez
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  3. Amany Faheem
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  4. Doaa El Amrousy
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Contributions

Doaa El Amrousy (D.E.) collected the the study data, helped in the recruitment of the patients, and wrote the manuscript. A.S. collected the the study data, wrote the manuscript, performed the statistical analysis, and helped in the recruitment of the patients. A.F. collected the the study data, helped in the recruitment of the patients, revised and approved the final version of the manuscript. M.M. has revised, edited, and accepted the final version of the manuscript.

Corresponding author

Correspondence to Doaa El Amrousy.

Ethics declarations

Conflict of interest

none to declare.

Clinical trial registration

The study was registered at Pan African Clinical Trials Registry (PACTR) www.pactr.samrc.ac.za with trial number PACTR201907742119058.

Ethical approval

Local ethics committee of Faculty of Medicine, Tanta University approved the study. The study is in accordance with the ethical standards of institutional research committee and with the 1964 Helsinki declaration and its later amendments.

Consent to participate

an informed consent was obtained from the parents of all subjects of the study before enrollment.

Consent to publication

All the authors transfer, assign, or otherwise convey all copyright ownership, including any and all rights exclusively to the journal, in the event that such work is published by the journal.

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Available when required.

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not applicable.

Additional information

Communicated by Daniele De Luca

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Salamah, A., Mehrez, M., Faheem, A. et al. Efficacy of Citicoline as a Neuroprotector in children with post cardiac arrest: a randomized controlled clinical trial. Eur J Pediatr 180, 1249–1255 (2021). https://doi.org/10.1007/s00431-020-03871-6

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  • DOI: https://doi.org/10.1007/s00431-020-03871-6

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