The dynamic pathophysiology of post cardiac arrest brain injury: "time is brain".

IF 3.4 3区医学 Q1 CRITICAL CARE MEDICINE

Current Opinion in Critical Care Pub Date : 2025-02-28 DOI:10.1097/MCC.0000000000001246

Chloe P Allen, Jordan D Bird, Mypinder S Sekhon

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引用次数: 0

Abstract

Purpose of review: To review the time dependent nature of postcardiac arrest brain injury (PCABI) while contextualizing clinical trial evidence.

Recent findings: PCABI represents a dynamic entity with respect to its pathophysiology. Intuitively, PCABI pathophysiology has been characterized focusing on mechanisms associated with cerebral ischemia. Interventions that augment cerebral oxygen delivery, such as increasing mean arterial pressure, have garnered interest. Regrettably, these trials have not demonstrated improved outcomes. At the core of this conundrum is the time dependent nature of PCABI pathophysiology with trials employing interventions approximately 4-6 h after return of spontaneous circulation (ROSC). This therapeutic window is likely far past the efficacy period of resumption of oxygen delivery to the ischemic brain. Thus, we suggest compartmentalizing PCABI into four phases: circulatory arrest; intra-arrest physiology; immediate reperfusion; and delayed reperfusion. Culprit mechanisms are discussed for each phase with contextualization of recent trial results.

Summary: PCABI has dynamic pathophysiology and restoration of cerebral oxygen delivery in a delayed manner from ROSC has diminished efficacy. PCABI pathophysiology must be viewed in a time dependent manner and interventions aimed at restoring cerebral oxygen delivery are likely only to be efficacious if applied immediately after ROSC.

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心脏骤停后脑损伤的动态病理生理学：“时间就是大脑”。

回顾的目的：回顾心脏骤停后脑损伤（PCABI）的时间依赖性，同时结合临床试验证据。最近的研究发现：PCABI在病理生理方面是一个动态的实体。直观地说，PCABI的病理生理特征集中在脑缺血相关机制上。增加脑氧输送的干预措施，如增加平均动脉压，已经引起了人们的兴趣。遗憾的是，这些试验并没有显示出改善的结果。这个难题的核心是PCABI病理生理的时间依赖性，在自发循环恢复（ROSC）后大约4-6小时采用干预措施。这个治疗窗口期很可能远远超过恢复缺血脑供氧的有效期。因此，我们建议将PCABI分为四个阶段：循环骤停；intra-arrest生理学;直接再灌注;再灌注延迟。在最近的试验结果的背景下，讨论了每个阶段的罪魁祸首机制。摘要：PCABI具有动态病理生理，ROSC延迟恢复脑氧输送的效果减弱。PCABI病理生理必须以一种时间依赖性的方式来看待，旨在恢复脑氧输送的干预措施可能只有在ROSC后立即应用才有效。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Current Opinion in Critical Care 医学-危重病医学

CiteScore

5.90

自引率

3.00%

发文量

172

审稿时长

6-12 weeks

期刊介绍： Current Opinion in Critical Care delivers a broad-based perspective on the most recent and most exciting developments in critical care from across the world. Published bimonthly and featuring thirteen key topics – including the respiratory system, neuroscience, trauma and infectious diseases – the journal’s renowned team of guest editors ensure a balanced, expert assessment of the recently published literature in each respective field with insightful editorials and on-the-mark invited reviews.