Anoxic Brain Injury: The Abominable Malady

Ajay P. Hrishi; Unnikrishnan Prathapadas; Karen R. Lionel; Divya K. Puthanveedu; Manikandan Sethuraman

doi:10.1055/s-0039-1688406

Journal of Neuroanaesthesiology and Critical Care, Table of Contents

CC BY-NC-ND 4.0 · J Neuroanaesth Crit Care 2019; 06(02): 096-104
DOI: 10.1055/s-0039-1688406

Review Article

Indian Society of Neuroanaesthesiology and Critical Care

Anoxic Brain Injury: The Abominable Malady

Ajay P. Hrishi

¹Neuroanaesthesia Division, Department of Anaesthesiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India

,

Unnikrishnan Prathapadas

¹Neuroanaesthesia Division, Department of Anaesthesiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India

,

Karen R. Lionel

²Department of Anaesthesiology, Christian Medical College, Vellore, Tamil Nadu, India

,

Divya K. Puthanveedu

³Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India

,

Manikandan Sethuraman

¹Neuroanaesthesia Division, Department of Anaesthesiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India

› Author Affiliations

Abstract

Anoxic brain injury (ABI) is an important cause of prolonged hospital stay and morbidity across the globe. It is a sequel of major systemic insults resulting from various etiologies, such as reduced oxygen availability, insufficient cerebral blood flow, reduced oxygen carriage, or any metabolic condition that can interfere with the utilization of oxygen. A varying combination of pathophysiologic mechanisms leads to a spectrum of clinical manifestations, the understanding of which will significantly help in prognostication of patients. Neuroprognostication helps both the clinician and the patient's family in planning future course and is further aided by various neuromonitoring modalities, biomarkers, and imaging. Targeted temperature management still remains a therapeutic tool in ABI and along with other neuroprotective measures may improve the survival. Continuing research in ABI may uncover more promising treatment strategies.

Keywords

anoxic brain injury - neuroprognostication - targeted temperature management - hypothermia

Full Text

References

References
1 Butterworth Roger F. Hypoxic Encephalopathy. Basic Neurochemistry: Molecular, Cellular and Medical Aspects. 6th ed.. Philadelphia: Lippincott Williams & Wilkins; 1999: 50-78
2 Wassink G, Gunn ER, Drury PP, Bennet L, Gunn AJ. The mechanisms and treatment of asphyxial encephalopathy. Front Neurosci 2014; 8: 40-43
3 Lo EH, Dalkara T, Moskowitz MA. Mechanisms, challenges and opportunities in stroke. Nat Rev Neurosci 2003; 4 (05) 399-415
4 Seta KA, Yuan Y, Spicer Z. et al. The role of calcium in hypoxia-induced signal transduction and gene expression. Cell Calcium 2004; 36 (03) (04) 331-340
5 Custodio CM, Basford JR. Delayed postanoxic encephalopathy: a case report and literature review. Arch Phys Med Rehabil 2004; 85 (03) 502-505
6 Vaagenes P, Ginsberg M, Ebmeyer U. et al. Cerebral resuscitation from cardiac arrest: pathophysiologic mechanisms. Crit Care Med 1996; 24 (02) Suppl S57-S68
7 Sheth RD, Bodensteiner JB. Delayed postanoxic encephalopathy: possible role for apoptosis. J Child Neurol 1998; 13 (07) 347-348
8 Gottfried JA, Mayer SA, Shungu DC, Chang Y, Duyn JH. Delayed posthypoxic demyelination. Association with arylsulfatase A deficiency and lactic acidosis on proton MR spectroscopy. Neurology 1997; 49 (05) 1400-1404
9 Oddo M, Rossetti AO. Predicting neurological outcome after cardiac arrest. Curr Opin Crit Care 2011; 17 (03) 254-259
10 Caronna JJ, Finklestein S. Neurological syndromes after cardiac arrest. Stroke 1978; 9 (05) 517-520
11 Young GB, Doig G, Ragazzoni A. Anoxic-ischemic encephalopathy: clinical and electrophysiological associations with outcome. Neurocrit Care 2005; 2 (02) 159-164
12 Levy DE, Caronna JJ, Singer BH, Lapinski RH, Frydman H, Plum F. Predicting outcome from hypoxic-ischemic coma. JAMA 1985; 253 (10) 1420-1426
13 Young GB. Clinical practice. Neurologic prognosis after cardiac arrest. N Engl J Med 2009; 361 (06) 605-611
14 Krumholz A, Stern BJ, Weiss HD. Outcome from coma after cardiopulmonary resuscitation: relation to seizures and myoclonus. Neurology 1988; 38 (03) 401-405
15 Amalnath SD, Kumar S, Deepanjali S, Dutta TK. Balint syndrome. Ann Indian Acad Neurol 2014; 17 (01) 10-11
16 Clerget L, Lenfant F, Roy H, Giroud M, Ben Salem D, Freysz M. Man-in-the-barrel syndrome after hemorrhagic shock. J Trauma 2003; 54 (01) 183-186
17 Morimoto Y, Kemmotsu O, Kitami K, Matsubara I, Tedo I. Acute brain swelling after out-of-hospital cardiac arrest: pathogenesis and outcome. Crit Care Med 1993; 21 (01) 104-110
18 Scollo-Lavizzari G, Bassetti C. Prognostic value of EEG in post-anoxic coma after cardiac arrest. Eur Neurol 1987; 26 (03) 161-170
19 Legriel S, Bruneel F, Sediri H. et al. Early EEG monitoring for detecting postanoxic status epilepticus during therapeutic hypothermia: a pilot study. Neurocrit Care 2009; 11 (03) 338-344
20 Gendo A, Kramer L, Häfner M. et al. Time-dependency of sensory evoked potentials in comatose cardiac arrest survivors. Intensive Care Med 2001; 27 (08) 1305-1311
21 Madl C, Kramer L, Domanovits H. et al. Improved outcome prediction in unconscious cardiac arrest survivors with sensory evoked potentials compared with clinical assessment. Crit Care Med 2000; 28 (03) 721-726
22 Greer D, Scripko P, Bartscher J. et al. Clinical MRI interpretation for outcome prediction in cardiac arrest. Neurocrit Care 2012; 17 (02) 240-244
23 Wu O, Sorensen AG, Benner T, Singhal AB, Furie KL, Greer DM. Comatose patients with cardiac arrest: predicting clinical outcome with diffusion-weighted MR imaging. Radiology 2009; 252 (01) 173-181
24 Zingler VC, Krumm B, Bertsch T, Fassbender K, Pohlmann-Eden B. Early prediction of neurological outcome after cardiopulmonary resuscitation: a multimodal approach combining neurobiochemical and electrophysiological investigations may provide high prognostic certainty in patients after cardiac arrest. Eur Neurol 2003; 49 (02) 79-84
25 Reisinger J, Höllinger K, Lang W. et al. Prediction of neurological outcome after cardiopulmonary resuscitation by serial determination of serum neuron-specific enolase. Eur Heart J 2007; 28 (01) 52-58
26 Maramattom BV, Wijdicks EFM. Postresuscitation encephalopathy. Current views, management, and prognostication. Neurologist 2005; 11 (04) 234-243
27 Sandroni C, Cavallaro F, Callaway CW. et al. Predictors of poor neurological outcome in adult comatose survivors of cardiac arrest: a systematic review and meta-analysis. Part 1: patients not treated with therapeutic hypothermia. Resuscitation 2013; 84 (10) 1310-1323
28 Sandroni C, Cavallaro F, Callaway CW. et al. Predictors of poor neurological outcome in adult comatose survivors of cardiac arrest: a systematic review and meta-analysis. Part 2: Patients treated with therapeutic hypothermia. Resuscitation 2013; 84 (10) 1324-1338
29 Bernard SA, Gray TW, Buist MD. et al. Treatment of comatose survivors of out-of-hospital cardiac arrest with induced hypothermia. N Engl J Med 2002; 346 (08) 557-563
30 Nichol G, Huszti E, Kim F. et al; American Heart Association Get With the Guideline-Resuscitation Investigators. Does induction of hypothermia improve outcomes after in-hospital cardiac arrest?. Resuscitation 2013; 84 (05) 620-625
31 Hypothermia after Cardiac Arrest Study Group. Mild therapeutic hypothermia to improve the neurologic outcome after cardiac arrest. N Engl J Med 2002; 346 (08) 549-556
32 Nolan JP, Morley PT, Vanden Hoek TL. et al; International Liaison Committee on Resuscitation. Therapeutic hypothermia after cardiac arrest: an advisory statement by the advanced life support task force of the International Liaison Committee on Resuscitation. Circulation 2003; 108 (01) 118-121
33 Holzer M, Bernard SA, Hachimi-Idrissi S, Roine RO, Sterz F, Müllner M. Collaborative Group on Induced Hypothermia for Neuroprotection After Cardiac Arrest. Hypothermia for neuroprotection after cardiac arrest: systematic review and individual patient data meta-analysis. Crit Care Med 2005; 33 (02) 414-418
34 Nielsen N, Wetterslev J, Cronberg T. et al; TTM Trial Investigators. Targeted temperature management at 33°C versus 36°C after cardiac arrest. N Engl J Med 2013; 369 (23) 2197-2206
35 Link MS, Berkow LC, Kudenchuk PJ. et al. Part 7: Adult Advanced Cardiovascular Life Support: 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 2015; 132 (18) (Suppl. 02) S444-S464
36 Chan PS, Berg RA, Tang Y, Curtis LH, Spertus JA. American Heart Association's Get With the Guidelines–Resuscitation Investigators. Association between therapeutic hypothermia and survival after in-hospital cardiac arrest. JAMA 2016; 316 (13) 1375-1382
37 Kirkegaard H, Søreide E, de Haas I. et al. Targeted temperature management for 48 vs 24 hours and neurologic outcome after out-of-hospital cardiac arrest: a randomized clinical trial. JAMA 2017; 318 (04) 341-350