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Brain Hypothermia After Resuscitation from Cardiopulmonary Arrest

  • Nariyuki Hayashi
  • Dalton W. Dietrich

Abstract

A recent clinical trial of brain hypothermia for postresuscitation management of cardiopulmonary arrest (CPA) patients demonstrated the effectiveness of the treatment [3,14,17,18]. The concept and mechanism of hypothermia are similar to those in experimental animal studies, such as the prevention of brain edema and free radical reactions after reperfusion, and management of brain hypoxia [2,3,17,20,21]. However, the brain injury mechanism after cardiac arrest in humans is not similar to that in anesthetized experimental animal models [7,8,13]. Stress to the hypothalamuspituitary- adrenal (HPA) axis [4] and excess neurohormonal reactions [15,16] after cardiac arrest produces brain injury mechanisms that were not observed in anesthetized experimental animal models [11,12]. Insulin-resistant hyperglycemia associated with epinephrine surge [7,9, 10, 11] and slow release of bound oxygen from hemoglobin [5,11] that produces ineffective oxygen inhalation are major issues at the acute stage after resuscitation from cardiac arrest (Fig. 107).

Keywords

Cardiac Arrest Brain Edema Brain Injured Patient Mild Therapeutic Hypothermia Oxygen Inhalation 
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.
    American Heart Association (2002) Guidelines 2000 for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation 102:1–383Google Scholar
  2. 2.
    Baker AJ, Zornow MH, Scheller MS, Yaksh TL, Skilling SR, Smullin DH, Larson AA, Kuczenski R (1991) Changes in extracellular concentrations of glutamate, aspartate, glycine, dopamine, serotonin, and dopamine metabolites after transient global ischemia in the rat. J Neurochem 57:1370–1379PubMedCrossRefGoogle Scholar
  3. 3.
    Bernard SA, Gray TW, Buist MD, Jones BM, Silvester W, Gutteridge G, Smith K (2002) Treatment of comatose survivors of out-of-hospital cardiac arrest with induced hypothermia. N Engl J Med 346:557–563PubMedCrossRefGoogle Scholar
  4. 4.
    Corte FD, Mancini A, Valle D, Gallizzi F, Carducci P, Mignani V, De Marinis L (1998) Provocative hypothalamopituitary axis tests in severe head injury: correlation with severity and prognosis. Crit Care Med 26:1419–1426PubMedCrossRefGoogle Scholar
  5. 5.
    Dudariev VP, Lanovenko II (1999) Changes in the oxygen-binding properties of the blood in white rats under the influence of hypoxia and its pharmacological correction. Fiziol Zh 45:97–103PubMedGoogle Scholar
  6. 6.
    Gussak I, Chaitman BR, Kopecky SL, Nerbonne JM (2000) Rapid ventricular repolarization in rodents: electrocardiographic manifestations, molecular mechanisms, and clinical insights. J Electrocardiol 33:159–170PubMedCrossRefGoogle Scholar
  7. 7.
    Hayashi N (1995) Cerebral hypothermia treatment. In: Hayashi N (ed) Cerebral hypothermia treatment. Sogo Igaku, Tokyo, pp 1–105Google Scholar
  8. 8.
    Hayashi N (1996) Advance of cerebral hypothermia treatment. J Critical Med 8:295–300Google Scholar
  9. 9.
    Hayashi N (1997) Combination therapy of cerebral hypothermia, pharmacological activation of the dopamine system, and hormonal replacement in severely brain damaged patients. J Jpn Soc Intensive Care Med 4:191–197CrossRefGoogle Scholar
  10. 10.
    Hayashi N (1997) Prevention of vegetation after severe head trauma and stroke by combination therapy of cerebral hypothermia and activation of immunedopaminergic nervous system. Proc Soc Treat Coma 6: 133–145Google Scholar
  11. 11.
    Hayashi N (2000) Enhanced neuronal damage in severely brain injured patients by hypothalamus, pituitary, and adrenal axis neuro-hormonal changes. In: Hayashi N (ed) Brain hypothermia. Springer, Berlin Heidelberg New York Tokyo, pp 3–26CrossRefGoogle Scholar
  12. 12.
    Hayashi N (2000) The clinical issue and effectiveness of brain hypothermia treatment for severe brain injured patients. In: Hayashi N (ed) Brain hypothermia. Springer, Berlin Heidelberg New York Tokyo, pp 121–151CrossRefGoogle Scholar
  13. 13.
    Hayashi N, Nagso K, Utagawa A, Sakurai A (2001) The push back of life edge from cardiac death by combination therapy with percutaneous cardiopulmonary support and brain hypothermia treatment in cardiac arrested patients. Cardiovasc Med Surg 3:68–77Google Scholar
  14. 14.
    Holzer M, Cerchiari E, Martens P, Roine R, Strez F (2002) Mild therapeutic hypothermia to improve the neurologic outcome after cardiac arrest. N Engl J Med 346:549–555CrossRefGoogle Scholar
  15. 15.
    Leibowitz SF (1999) Macronutrients and brain peptides: what they do and how they respond. In: Berthoud HR, Seeley RJ (eds) Neural and metabolic control of macronutrient intake. CRC, Boca Raton, pp 389–406Google Scholar
  16. 16.
    Leibowiz SF, Sladek C, Spencer L, Temple D (1988) Neuropeptide Y, epinephrine and norepinephrine in the paraventricular nucleus: stimulation of feeding and the release of corticosterone, vasopressin and glucose. Brain Res Bull 21:905CrossRefGoogle Scholar
  17. 17.
    Leonov Y, Sterz F, Safar P, Radovsky A, Oku K, Tisherman S, Stezoski SW (1990) Mild cerebral hypother mia during and after cardiac arrest improves neurologic outcome in dogs. J Cereb Blood Flow Metab 10:57–70PubMedCrossRefGoogle Scholar
  18. 18.
    Nagao K, Hayashi N, Kanmatsuse K, Arima K, Ohtsuki J, Kikushima K, Watanabe I (2000) Cardiopulmonary cerebral resuscitation using emergency cardiopulmonary bypass, coronary reperfusion therapy and mild hypothermia in patients with cardiac arrest outside the hospital. J Am Coll Cardiol 36:776–783PubMedCrossRefGoogle Scholar
  19. 19.
    Okamoto K, Nagao K, Miki T, Nitobe E, Arima K, Hayashi N (2000) New hypothermia method using bloodcooling system: Monan and Kanem method. In: Hayashi N (ed) Brain Hypothermia. Springer, Berlin Heidelberg New York Tokyo, pp 203–212CrossRefGoogle Scholar
  20. 20.
    Safar P, Behringer W, Bottiger BW, Sterz F (2002) Cerebral resuscitation potentials for cardiac arrest. Crit Care Med 30:S140–144CrossRefGoogle Scholar
  21. 21.
    Silvka A, Coben G (1985) Hydroxyl radical attack on dopamine. J Biol Chem 260:15466–15472Google Scholar
  22. 22.
    Vassallo SU, Delaney KA, Hoffman RS, Slater W, Goldfrank LR (1999) A prospective evaluation of the electrocardiographic manifestations of hypothermia. Acad Emerg Med 6:1121–1126PubMedCrossRefGoogle Scholar

Copyright information

© Springer Japan 2004

Authors and Affiliations

  • Nariyuki Hayashi
    • 1
    • 2
  • Dalton W. Dietrich
    • 3
    • 4
  1. 1.Nihon University Emergency Medical CenterTokyoJapan
  2. 2.Department of Emergency and Critical Care MedicineNihon University School of MedicineTokyoJapan
  3. 3.Department of Neurological Surgery, Neurology and Cell Biology and AnatomyUniversity of Miami School of MedicineMiamiUSA
  4. 4.The Miami Project to Cure ParalysisMiamiUSA

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