Protecting the Brain During and After Vascular Insufficiency

Abstract

After years of controversy and hosts of animal studies, the issue of barbiturate brain protection has been largely resolved based upon valid human studies which are supported by animal studies. Despite an initial enthusiastic endorsement by many clinicians, it can now be stated unequivocally that there is no place for barbiturate therapy following resuscitation from cardiac arrest. This was established in a prospective, randomized, multi-institutional trial in man which failed to demonstrate even a suggestion that barbiturates might favorably alter neurologic outcome.(1) Further this same result has been reported in all of the recent animal studies that addressed this question.(2–4) One presumed explanation for these negative results is simply that cerebral metabolic suppression by barbiturates (and other anesthetics) is not possible in the absence of an active EEG. The latter can be expected to remain isoelectric for many minutes following resuscitation.