title: Neuroprotective strategies and neuroprognostication after cardiac arrest.
abstract: Neurocognitive disturbances are common among survivors of cardiac arrest (CA). Although initial management of CA, including bystander cardiopulmonary resuscitation, optimal chest compression, and early defibrillation, has been implemented continuously over the last years, few therapeutic interventions are available to minimize or attenuate the extent of brain injury occurring after the return of spontaneous circulation. In this review, we discuss several promising drugs that could provide some potential benefits for neurological recovery after CA. Most of these drugs have been investigated exclusively in experimental CA models and only limited clinical data are available. Further research, which also considers combined neuroprotective strategies that target multiple pathways involved in the pathophysiology of postanoxic brain injury, is certainly needed to demonstrate the effectiveness of these interventions in this setting. Moreover, the evaluation of neurological prognosis of comatose patients after CA remains an important challenge that requires the accurate use of several tools. As most patients with CA are currently treated with targeted temperature management (TTM), combined with sedative drug therapy, especially during the hypothermic phase, the reliability of neurological examination in evaluating these patients is delayed to 72-96 h after admission. Thus, additional tests, including electrophysiological examinations, brain imaging and biomarkers, have been largely implemented to evaluate earlier the extent of brain damage in these patients.
authors.affiliation: Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles (ULB), Route de Lennik 808, 1070 Brussels, Belgium. Electronic address: ftaccone@ulb.ac.be.
authors.forename: Fabio Silvio
authors.initials: FS
authors.lastname: Taccone
authors.affiliation: Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles (ULB), Route de Lennik 808, 1070 Brussels, Belgium.
authors.forename: Ilaria Alice
authors.initials: IA
authors.lastname: Crippa
authors.affiliation: Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles (ULB), Route de Lennik 808, 1070 Brussels, Belgium.
authors.forename: Antonio Maria
authors.initials: AM
authors.lastname: Dell'Anna
authors.affiliation: Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles (ULB), Route de Lennik 808, 1070 Brussels, Belgium.
authors.forename: Sabino
authors.initials: S
authors.lastname: Scolletta
mesh_terms: D001930:Brain Injuries / Q000175:diagnosis* / Q000453:epidemiology / Q000517:prevention & control*; D006323:Heart Arrest / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy*; D006801:Humans; D018696:Neuroprotective Agents / Q000008:administration & dosage*; D011379:Prognosis
chemical_list: D018696:Neuroprotective Agents
keywords: cardiac arrest; neuroprotection; postanoxic injury; prognostication