A systematic review of currently available pharmacological neuroprotective agents as a sole intervention before anticipated or induced cardiac arrest.
We conducted a Medline search for controlled studies evaluating currently available drugs for pharmacological neuroprotection. They had to be administered prior to transient global cerebral ischaemia without further non-pharmacological measures. We deliberately excluded focal ischaemia since its pathophysiology is substantially different from global ischaemia. A total of 45 articles conducted exclusively in laboratory animals met these criteria. The following classes of agents were evaluated: anaesthetics, GABAergic drugs, calcium-antagonists, anticonvulsives, sodium-channel blockers, potassium-channel activators, NMDA-receptor antagonists, hormones, vasodilators, dopamine- and alpha2-agonists, magnesium, xanthine oxidase- and cyclooxygenase inhibitors, a nootropic, a protease inhibitor, and immunosuppressants. Some of them were applied chronically and others administered via clinically impracticable routes. The available literature favours isoflurane, phenytoin, lamotrigine, magnesium, and potentially, nimodipine, and flunarizine. If factors like costs, toxicity, side effects, route and mode of application are considered, isoflurane and MgSO4 that have also been safely applied to patients with compromised left ventricular pump function are advantageous but their true role in human neuroprotection remains unclear.
Weigl
Manuela
M
Department of Anaesthesiology and General Intensive Care, Division of Cardiothoracic and Vascular Anaesthesia and Intensive Care, University Hospital Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria.
Tenze
Giacomo
G
Steinlechner
Barbara
B
Skhirtladze
Keso
K
Reining
Georg
G
Bernardo
Mario
M
Pedicelli
Elisa
E
Dworschak
Martin
M
D000818:Animals; D002545:Brain Ischemia / Q000209:etiology / Q000517:prevention & control*; D002317:Cardiovascular Agents / Q000627:therapeutic use; D002491:Central Nervous System Agents / Q000627:therapeutic use; D004195:Disease Models, Animal; D004298:Dopamine / Q000627:therapeutic use; D004791:Enzyme Inhibitors / Q000627:therapeutic use; D004958:Estradiol / Q000627:therapeutic use; D006323:Heart Arrest / Q000150:complications / Q000517:prevention & control*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008274:Magnesium / Q000627:therapeutic use; D018696:Neuroprotective Agents / Q000627:therapeutic use*; D018377:Neurotransmitter Agents / Q000627:therapeutic use; D015221:Potassium Channels / Q000819:agonists; D011374:Progesterone / Q000627:therapeutic use; D016194:Receptors, N-Methyl-D-Aspartate / Q000037:antagonists & inhibitors
D002317:Cardiovascular Agents; D002491:Central Nervous System Agents; D004791:Enzyme Inhibitors; D007166:Immunosuppressive Agents; D018696:Neuroprotective Agents; D018377:Neurotransmitter Agents; D015221:Potassium Channels; D016194:Receptors, N-Methyl-D-Aspartate; D011374:Progesterone; D004958:Estradiol; D008274:Magnesium; D004298:Dopamine