Top Things to Know: Improving Outcomes After Post Cardiac Arrest Brain Injury
Published: June 27, 2024
- Two out of three people who initially survive a cardiac arrest will later die in hospital, the majority from post-cardiac arrest brain injury.
- The overarching goal of resuscitation is survival without neurological impairment, enabling the person to resume their pre–cardiac arrest level of function.
- The treatment of cardiac arrest and its sequelae consumes substantial health and social care resources.
- Post–cardiac arrest brain injury is characterized by 4 distinct but overlapping phases: ischemic depolarization, reperfusion repolarization, dysregulation, and recovery and repair.
- Failure to translate effective preclinical therapies to clinical practice can be attributed to limitations of preclinical models and clinical trial design that do not replicate how therapies are delivered in the preclinical setting.
- The complexity of post–cardiac arrest brain injury suggests that monotherapies are unlikely to be as successful as polydrug and multimodal neuroprotective therapies.
- Biomarkers of mechanistic target engagement should be developed to identify patients with the targeted mechanism of injury, to quantify its severity, and to measure the response to therapy.
- Future trials must tailor the correct therapy to the right patients at the appropriate time, dose and duration.
- Studies need to be adequately powered to detect effect sizes that are realistic and meaningful to patients, their families, and clinicians.
- Multidisciplinary and international collaboration will be essential to realize the goal of developing effective therapies for post–cardiac arrest brain injury.
Citation
Perkins GD, Neumar R, Hsu CH, Hirsch KG, Aneman A, Becker LB, Couper K, Callaway CW, Hoedemaekers CWE, Lim SL, Meurer W, Olasveengen T, Sekhon MS, Skrifvars M, Soar J, Tsai M-S, Vengamma B, Nolan JP; on behalf of the International Liaison Committee on Resuscitation. Improving outcomes after post–cardiac arrest brain injury:a scientific statement from the International Liaison Committee on Resuscitation. Circulation. Published online June 27, 2024. doi: 10.1161/CIR.0000000000001219