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Current Concepts in Brain Resuscitation

  • M. C. Rogers
  • J. R. Kirsch
Conference paper
Part of the Yearbook of Intensive Care and Emergency Medicine book series (YEARBOOK, volume 1995)

Abstract

While the initial impetus for intensive care 20 years ago grew out of major advances in cardiac and pulmonary care, the last decade has seen a tremendous interest in neurological intensive care. Several factors have combined to stimulate this interest. First, as intensivists provided better care to sicker patients with cardiac and pulmonary disease, critically ill patients survived more often and a review of their long-term complications noted a significant frequency of neurological problems. Next, as an outgrowth of the Vietnam War, techniques for rapid evacuation of casualties were used to improve treatment for traffic accident victims in the United States. The result was large numbers of hospitalized patients with head injury. Neurosurgical techniques designed to treat head- injured patients, including intracranial pressure (ICP) monitoring [1], became commonplace in tertiary care hospitals. Pharmacologic and physiological treatment for cerebral edema, developed for patients with head injury, was used in medical patients with conditions ranging from Reye’s syndrome [2] to near drowning [3]. As a result, neurological intensive care became a legitimate area of focus in critical care medicine.

Keywords

Cerebral Ischemia Cerebral Vasospasm Cereb Blood Flow Cerebral Metabolism Global Cerebral Ischemia 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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References

  1. 1.
    Lundberg N (1960) Continuous recording and control of ventricular fluid pressure in neurosurgical practice. Acta Psychiatr Neurol Scand 36 (suppl 149): 1–193Google Scholar
  2. 2.
    David RB, Vries JK, Mamunes P (1975) Intracranial pressure monitoring in Reye’s syndrome. In: Pollack JD (ed) Reye’s Syndrome. Grune & Stratton, New York, NY, pp 309–313Google Scholar
  3. 3.
    Nugent SK, Rogers MC (1980) Resuscitation and intensive care monitoring following immersion hypothermia. J Trauma 20: 814–815PubMedCrossRefGoogle Scholar
  4. 4.
    Langfitt TW (1973) Increased intracranial pressure. In: Youmans TP (ed) Neurologic Surgery. WB Saunders Co, Philadelphia, PA, pp 846–930Google Scholar
  5. 5.
    Gordon E (1971) Controlled respiration in the management of patients with traumatic brain injuries. Acta Anaesth Scand 15: 193–208PubMedCrossRefGoogle Scholar
  6. 6.
    Vries JK, Becker DP, Young HF (1973) A subarachnoid screw for monitoring intracranial pressure. J Neurosurg 39: 416–419PubMedCrossRefGoogle Scholar
  7. 7.
    Langfitt TW (1973) Summary of the First International Symposium on Intracranial Pressure, Hannover, Germany, July 27–29, 1972. J Neurosurg 38: 541–546PubMedCrossRefGoogle Scholar
  8. 8.
    Arnfred I, Secher O (1962) Anoxia and barbiturates. Arch Int Pharmacodyn Ther 139: 67–74Google Scholar
  9. 9.
    Wilhjelm BJ, Arnfred I (1965) Protective action of some anesthestics against anoxia. Acta Pharm Toxicol 22: 93–98CrossRefGoogle Scholar
  10. 10.
    Secher O, Wilhjelm B (1968) The protective action of anaesthetics against hypoxia. Can Anaesth Soc J 15: 423–440PubMedCrossRefGoogle Scholar
  11. 11.
    Bleyaerth AL, Nemoto EM, Safar P, et al (1978) Thiopental amelioration of brain damage after global ischemia in monkeys. Anesthesiology 49: 390–398CrossRefGoogle Scholar
  12. 12.
    Shapiro HM (1975) Intracranial hypertension: Therapeutic and anesthetic considerations. Anesthesiology 43: 445–471PubMedCrossRefGoogle Scholar
  13. 13.
    Caniano DA, Nugent SK, Rogers MC, Haller JA (1980) Intracranial pressure monitoring in the management of the pediatric trauma patient. J Pediatr Surg 15: 537–542PubMedCrossRefGoogle Scholar
  14. 14.
    Dodge PR, Brown SB, Ector WL, et al (1981) The diagnosis and treatment of Reye’s syndrome. Nat Inst Health Consensus Dev Conf Consensus Statement 4: 1–15Google Scholar
  15. 15.
    Nugent SK, Bausher JA, Moxon ER, Rogers MC (1979) Management of raised intracranial pressure in meningitidis meningoencephalitis. Am J Dis Child 33: 260–262Google Scholar
  16. 16.
    Dempsey RJ, Kindt GW (1982) Experimental acute hepatic encephalopathy: Relationship of pathological cerebral vasodilatation to increased intracranial pressure. Neurosurgery 10: 737–742PubMedCrossRefGoogle Scholar
  17. 17.
    Safar P, Bleyaert A, Nemoto EM, Moossy J, Snyder JV (1978) Resuscitation after global brain ischemia-anoxia. Crit Care Med 16: 215–227CrossRefGoogle Scholar
  18. 18.
    Donegan JH, Traystman RJ, Koehler RC, Jones MD, Rogers MC (1985) Cerebrovascular hypoxic and autoregulatory responses during reduced brain metabolism. Am J Physiol 249: H421–H429PubMedGoogle Scholar
  19. 19.
    Conn AW, Barker GA (1984) Freshwater drowning and near-drowning: An update. Can Anaesth Soc J 31: 538–544CrossRefGoogle Scholar
  20. 20.
    Rogers MC (1985) Near-drowning: Cold water on a hot topic? J Pediatr 106: 603–604PubMedCrossRefGoogle Scholar
  21. 21.
    Brain Resuscitation Clinical Trial I Study Group (1986) Randomized clinical study of thiopental loading in comatose survivors of cardiac arrest. N Engl J Med 314: 397–403CrossRefGoogle Scholar
  22. 22.
    Gisvold SE, Safar P, Hendricks HHL, Roa G, Moossy J, Alexander H (1984) Thiopental treatment after global brain ischemia in pigtailed monkeys. Anesthesiology 60: 88–96PubMedCrossRefGoogle Scholar
  23. 23.
    Smith AL, Hoff JT, Nielsen SL, Larson CP (1974) Barbiturate protection in acute focal cerebral ischemia. Stroke 5: 1–7PubMedCrossRefGoogle Scholar
  24. 24.
    Nussmeier NA, Arlund C, Slogoff S (1986) Neuropsychiatric complications after cardiopulmonary bypass: Cerebral protection by a barbiturate. Anesthesiology 64: 165–170PubMedCrossRefGoogle Scholar
  25. 25.
    Stevenson RL, Rogers MC (1988) Barbiturates for brain protection during cardiopulmonary bypass: Fact or fantasy? J Cardiothor Anesth 2: 390–392CrossRefGoogle Scholar
  26. 26.
    Jugdutt BI, Rogers MC, Hutchins GM, Becker LC (1986) Increased myocardial infarct size by thiopental after coronary occlusion in the dog. Am Heart J 112: 485–494PubMedCrossRefGoogle Scholar
  27. 27.
    Gelmers HJ, Gorter K, DeWeerdt CJ, Wiezer HJA (1988) A controlled trial of nimodipine in acute ischemic stroke. N Engl J Med 318: 203–207PubMedCrossRefGoogle Scholar
  28. 28.
    Gelmers HJ (1984) The effects of nimodipine on the clinical course of patients with acute ischemic stroke. Acta Neurol Scand 69: 232–239PubMedCrossRefGoogle Scholar
  29. 29.
    White BC, Winegar CD, Wilson RF, Hoehner PJ, Trombley JH Jr (1983) Possible role of calcium blockers in cerebral resuscitation: A review of the literature and synthesis for future studies. Crit Care Med 11: 202–207PubMedCrossRefGoogle Scholar
  30. 30.
    White BC, Gadzinski DS, Hoehner PJ, et al (1982) Effect of flunarizine on canine cerebral cortical blood flow and vascular resistance post-cardiac arrest. Ann Emerg Med 11: 119–126PubMedCrossRefGoogle Scholar
  31. 31.
    White BC, Winegar CD, Wilson RF, Krause GS (1983) Calcium blocker in cerebral resuscitation. J Trauma 23: 788–794PubMedCrossRefGoogle Scholar
  32. 32.
    Dean JM, Hoehner PJ, Rogers MC, Traystman RF (1984) Effect of lidoflazine on cerebral blood flow following twelve minutes total cerebral ischemia. Stroke 15: 531–535PubMedCrossRefGoogle Scholar
  33. 33.
    Steen PA, Newberg LA, Milde JH, Michenfelder JD (1983) Nimodipine improves cerebral blood flow and neurologic recovery after complete cerebral ischemia in the dog. J Cereb Blood Flow Metab 13: 38–43CrossRefGoogle Scholar
  34. 34.
    Steen PA, Newberg LA, Milde JH, Michenfelder JD (1984) Cerebral blood flow and neurologic outcome when nimodipine is given after complete cerebral ischemia in the dog. J Cereb Blood Flow Metab 4: 82–87PubMedCrossRefGoogle Scholar
  35. 35.
    McCord JM (1985) Oxygen-derived free radicals in postischemic tissue injury. N Engl J Med 312: 159–163PubMedCrossRefGoogle Scholar
  36. 36.
    Siesjo BK (1981) Cell damage in the brain: A speculative synthesis. J Cereb Blood Flow Metab 1: 155–185PubMedCrossRefGoogle Scholar
  37. 37.
    Siesjo BK, Wieloch T (1985) Cerebral metabolism in ischemia: Neurochemical basis for therapy. Br J Anaesth 57: 47–62PubMedCrossRefGoogle Scholar
  38. 38.
    Kontos HA, Wei EP, Povlishock JT, Christman CW (1984) Oxygen radicals mediate the cerebral arteriolar dilation from arachidonate and bradykinin in cats. Circ Res 55: 295–303PubMedGoogle Scholar
  39. 39.
    Granger DN, Rutili G, McCord JM (1981) Superoxide radicals in feline intestinal ischemia. Gastroenterology 81: 22–29PubMedGoogle Scholar
  40. 40.
    Haglund U, Lundgren O (1978) Intestinal ischemia and shock factors. Feder Proc 37: 2729–2733Google Scholar
  41. 41.
    Burton KP, McCord JM, Ghai G (1984) Myocardial alterations due to free-radical generation. Am J Physiol 246: H776–H783PubMedGoogle Scholar
  42. 42.
    Gardner TJ, Stewart JR, Casale AS, Downey JM, Chambers DE (1983) Reduction of myocardial ischemic injury with oxygen-derived free radical scavengers. Surgery 94: 423–427PubMedGoogle Scholar
  43. 43.
    Jolly SR, Kane WJ, Bailie MB, Abrams GD, Lucchessi BR (1984) Canine myocardial reperfusion injury: Its reduction by the combined administration of superoxide dismutase and catalase. Circ Res 54: 277–285PubMedGoogle Scholar
  44. 44.
    Demopoulos HB, Flamm ES, Pietronigro DD, Seligman ML (1980) The free radical pathology and the microcirculation in the major central nervous system disorders. Acta Physiol Scand 492 (Suppl): 91–119Google Scholar
  45. 45.
    Flamm E, Demopoulos HB, Seligman ML, Poser RG, Ransohoff J (1978) Free radicals in cerebral ischemia. Stroke 9: 445–447PubMedCrossRefGoogle Scholar
  46. 46.
    Rehncrona S (1984) Free radicals in brain ischemia. Med Biol 62: 122v124Google Scholar
  47. 47.
    Siesjo B, et al (1980) Neuronal cell damage in the brain: Possible involvement of oxidative mechanisms. Acta Physiol Scand 492 (Suppl): 121–128Google Scholar
  48. 48.
    Itoh T, Kawakami M, Yamauchi Y, Shimizu S, Nakamura M (1986) Effect of allopurinol on ischemia and reperfusion-induced cerebral injury in spontaneously hypertensive rats. Stroke 17: 1284–1287PubMedCrossRefGoogle Scholar
  49. 49.
    Meyer FB, Sundt TM, Yanagihara T, Anderson RE (1987) Focal cerebral ischemia: Pathophysiologic mechanisms and rationale for future avenues of treatment. Mayo Clin Proc 62: 35–55PubMedGoogle Scholar
  50. 50.
    Lim KH, Connolly M, Rose D, et al (1986) Prevention of reperfusion injury of the ischemic spinal cord: Use of recombinant superoxide dismutase. Ann Thorac Surg 42: 282–286PubMedCrossRefGoogle Scholar
  51. 51.
    Beckman JS, Minor RL Jr, White CW, Repine JE, Rosen GM, Freeman BA (1988) Superoxide dismutase and catalase conjugated to polyethylene glycol increases endothelial enzyme activity and oxidant resistance. J Biol Chem 263: 6884–6892PubMedGoogle Scholar
  52. 52.
    Cerchiari EL, Hoel TM, Safar P, Sclabassi RJ (1987) Protective effects of combined superoxide dismutase and deferoxamine on recovery of cerebral blood flow and function after cardiac arrest in dogs. Stroke 18: 869–878PubMedCrossRefGoogle Scholar
  53. 53.
    Fleischer JE, Lanier WL, Milde JH, Michenfelder JD (1987) Failure of deferoxamine, an iron chelator, to improve neurologic outcome following complete cerebral ischemia in dogs. Stroke 18: 124–127PubMedCrossRefGoogle Scholar
  54. 54.
    Kompala SD, Babbs CF, Blako KE (1986) Effect of deferoxamine on late deaths following CRP in rats. Ann Emerg Med 15: 405–407PubMedCrossRefGoogle Scholar
  55. 55.
    Liu TH, Beckman JS, Freeman BA, Hogan EL, Hsu Cy (1989) Polyethylene glycol-conjugated dismutase and catalase reduce ischemic brain injury. Am J Physiol 256: H589–H593PubMedGoogle Scholar
  56. 56.
    Yamamoto M, Shima T, Uozumi T, Sogabe T, Yamada K, Kawasaki T (1983) A possible role of lipid peroxidation in cellular damages caused by cerebral ischemia and the protective effect of alpha-tocopherol administration. Stroke 14: 977–982PubMedCrossRefGoogle Scholar
  57. 57.
    Coles JC, Ahmed SN, Mehta HU, Kaufman CE (1986) Role of free radical scavenger in protection of spinal cord during ischemia. Ann Thorac Surg 41: 551–556PubMedCrossRefGoogle Scholar
  58. 58.
    McGraw CP (1983) Treatment of cerebral infarction with dimethyl sulfoxide in the Mongolian gerbil. Ann NY Acad Sci 411: 278–285PubMedCrossRefGoogle Scholar
  59. 59.
    Little JR (1979) Treatment of acute focal cerebral ischemia with intermittent, low dose mannitol. Neurosurgery 5: 687–691PubMedCrossRefGoogle Scholar
  60. 60.
    Braughler JM, Chase RL, Neff GL, et al (1988) A new 21-aminosteroid antioxidant lacking glucocorticoid activity stimulates adrenocorticotropin secretion and blocks arachidonic acid release from mouse pituitary tumor (AtT-20) cells. J Pharmacol Exp Ther 244: 423–427PubMedGoogle Scholar
  61. 61.
    Natale JE, Schott, RJ, Hal ED, et al (1988) Effect of the aminosteroid U74006F after cardiopulmonary arrest in dogs. Stroke 19: 1371–1378PubMedCrossRefGoogle Scholar
  62. 62.
    Burrin JM, Hart GR (1990) Effects of a novel 21-amino steroid, U74006F, on the rat pituitary-adrenocortical axis. J Endocrinol 126: 203–209PubMedCrossRefGoogle Scholar
  63. 63.
    The STIPAS Investigators: (1980) Safety study of tirilazad mesylate in patients with acute ischemic stroke (STIPAS). Stroke 25: 418–423Google Scholar
  64. 64.
    Hulst LK, Fleishaker JC, Peters GR, et al (1994) Effect of age and gender on tirilazad pharmacokinetics in humans. Clin Pharmacol Ther 55: 378–384PubMedCrossRefGoogle Scholar
  65. 65.
    Sterz F, Safar P, Johnson DW, et al (1991) Effects of U74006F on multifocal cerebral blood flow and metabolism after cardiac arrest in dogs. Stroke 22: 889–895PubMedCrossRefGoogle Scholar
  66. 66.
    Hall ED, Yonkers PA (1988) Attenuation of postischemic cerebral hypoperfusion by the 21-aminosteroid U74006F. Stroke 19: 340–344PubMedCrossRefGoogle Scholar
  67. 67.
    Hall ED, Yonkers PA, McCall JM (1988) Attenuation of hemorrhagic shock by the nonglucocorticoid 21-aminosteroid U74006F. Eur J Pharmacol 147: 299–303PubMedCrossRefGoogle Scholar
  68. 68.
    Beck T, Bielenberg GW (1990) Failure of the lipid peroxidation inhibitor U740067 to improve neurological outcome after transient forebrain ischemia in the rat. Brain Res 532: 336–338PubMedCrossRefGoogle Scholar
  69. 69.
    Maruki Y, Koehler RC, Kirsch JR, et al (1991) Improved metabolic pH and evoked potential recovery after normoglycemic and hyperglycemic incomplete ischemia with 21-ami- nosteroid (U74006F) pretreatment. J Cereb Blood Flow Metab 11: S141 (Abst)Google Scholar
  70. 70.
    Clark WM, Hotan T, Lauten JD, et al (1994) Therapeutic efficacy of tirilazad in experimental multiple cerebral emboli: A randomized, controlled trial. Crit Care Med 22: 1161–1166PubMedCrossRefGoogle Scholar
  71. 71.
    Cotman CW, Iversen LL (1987) Excitatory amino acids in the brain — focus on NMDA receptors. Trends Neurosci 10: 263–265CrossRefGoogle Scholar
  72. 72.
    Schwarcz R, Meldrum B (1985) Excitatory amino acid antagonists provide a therapeutic approach to neurological disorders. Lancet 2: 140–143PubMedCrossRefGoogle Scholar
  73. 73.
    Olney JW, Fuller T, DeGubareff T (1979) Acute dendrotoxic changes in the hippocampus of kainate-treated rats. Brain Res 176: 91–100PubMedCrossRefGoogle Scholar
  74. 74.
    Olney JW (1974) Toxic effects of glutamate and related amino acids on the developing central nervous system. In: Nyhan WL (ed) Heritable discorders of amino acid metabolism. John Wiley & Sons, New York, NY, pp 489–501Google Scholar
  75. 75.
    Evans MC, Griffiths T, Meldrum BS (1983) Early hippocampal changes in the rat following bicuculine and L-allylglycine-induced seizures: A light and electron microscopic study. Neuropathol Appl Neurobiol 9: 39–52PubMedCrossRefGoogle Scholar
  76. 76.
    Evans MC, Griffiths T, Meldrum BS (1984) Kainic acid seizures and the reversibility of calcium loading in vulnerable neurons in the hippocampus. Neuropathol Appl Neurobiol 10: 285–302PubMedCrossRefGoogle Scholar
  77. 77.
    Sloviter RS (1983) Epileptic brain damage in rats induced by sustained electrical stimulation of the perforant path, I: Acute electrophysiological and light microscopic studies. Brain Res Bull 10: 675–697PubMedCrossRefGoogle Scholar
  78. 78.
    Sloviter RS, Dempster DW (1985) ‘Epileptic’ brain damage is replicated qualitatively in the rat hippocampus by central injection of glutamate or aspartate but not by GABA or acetylcholine. Brain Res Bull 15: 39–60PubMedCrossRefGoogle Scholar
  79. 79.
    Meldrum B (1985) Possible therapeutic applications of antagonists of excitatory amino acid neurotransmitters. Clin Sci 68: 113–122PubMedGoogle Scholar
  80. 80.
    Abdul-Ghani AS, Bruce D, Bradford HF (1982) Effect of glutamate dimethyl ester and glutamate diethyl ester in delaying the onset of convulsions induced by pentylenetetrazol and strychnine. Biochem Pharmacol 31: 3144–3146PubMedCrossRefGoogle Scholar
  81. 81.
    Croucher MJ, Collins JF, Meldrum BS (1982) Anticonvulsant action of excitatory amino acids antagonists. Science 216: 899–901PubMedCrossRefGoogle Scholar
  82. 82.
    Czuczwar SJ, Meldrum B (1982) Protection against chemically induced seizures by 2-ami- no-7-phosphonoheptanoic acid. Eur J Pharmacol 83: 335–338PubMedCrossRefGoogle Scholar
  83. 83.
    Meldrum BS, Croucher MJ, Czuczwar SJ, et al (1989) A comparison of the anticonvulsant potency of (±)2-amino-5-phosphonopentanoic acid and (±)2-amino-7-phosphonohepta- noic acid. Neuroscience 9: 925–930CrossRefGoogle Scholar
  84. 84.
    Izumiyama K, Kogure K (1988) Prevention of delayed neuronal death in gerbil hippocampus by ion channel blockers. Stroke 19: 1003–1007PubMedCrossRefGoogle Scholar
  85. 85.
    Park CK, Nehls DG, Graham DI, Teasdale GM, McCulloch J (1988) Focal cerebral ischaemia in the cat: Treatment with the glutamate antagonist MK-801 after induction of ischaemia. J Cereb Blood Flow Metab 8: 757–762PubMedCrossRefGoogle Scholar

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© Springer-Verlag Berlin Heidelberg 1995

Authors and Affiliations

  • M. C. Rogers
  • J. R. Kirsch

There are no affiliations available

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