Hitoshi Kano

Neuronal cell injury in patients after cardiopulmonary resuscitation: evaluation by diffusion-weighted imaging and magnetic resonance spectroscopy

Neuronal cell injury after global cerebral ischemic insult is not well understood in humans. We performed serial examination of diffusion-weighted imaging and magnetic resonance spectroscopy in three patients after cardiopulmonary resuscitation. The presence of the signal for lactate in magnetic resonance spectroscopy in the acute stage after cardiopulmonary resuscitation was closely correlated to irreversible damage. In addition, high intensity in diffusion-weighted magnetic resonance image in the acute stage also predicted a poor outcome. Lesions that were positive for these factors in the acute stage led to serious brain damage in the subacute and chronic stages. The results indicated that after cardiopulmonary resuscitation, diffusion-weighted magnetic resonance imaging and magnetic resonance spectroscopy is an extremely useful modality to estimate the prognosis of patients, which is not always easy using conventional methods.

Out-of-Hospital Cardiopulmonary Arrest Due to Penetrating Cardiac Injury Treated by Percutaneous Cardiopulmonary Support in the Emergency Room: Report of a Case

Penetrating cardiac injury tends to generally be repaired without cardiopulmonary bypass in the operating room. We herein report the case of penetrating cardiac injury repaired using percutaneous cardiopulmonary support in an emergency room. A 57-year-old man attempted suicide by stabbing himself in the left anterior chest with a knife. Although the patient suffered cardiopulmonary arrest for 7 min in the ambulance, spontaneous circulation was restored following pericardiotomy through emergency left thoracotomy in the emergency room. To prevent coronary artery injury and control the massive bleeding, percutaneous cardiopulmonary support was instituted without systemic heparinization and the cardiac injury was repaired in the emergency room. The patient was then transferred to another hospital on day 46 for further rehabilitation. Percutaneous cardiopulmonary support might be helpful for treating critical patients in an emergency room, even in the case of trauma patients.

Indication of Brain Hypothermic Therapy in Cardiac Arrest

It is known that mild brain hypothermic therapy (BHT) has reduced ischemic brain damage in a variety of animal experiments. However, this mechanism of the nerve protection effect is not yet clear, and has not been definitively validated by clinical study. The purpose of this study is to determine the indications for this therapy by multivariate analysis in order to determine the characteristics of patients who can expect to benefit most from this therapy. The design of the study was that of an observational historical cohort study. Patients who were resuscitated, and were able to subsequently live for more than 1 month, were candidates for the study. Patients received either BHT (32°–34°C, n = 36) or brain normothermic therapy (BNT; 36°–37°C, n = 18). Data were gathered on multiple event and patient treatment characteristics. The patient outcome was measured by the 1-month Glasgow Outcome Scale (GOS). Data were analyzed using univariate and multivariate techniques. Overall, 47.2% of patients receiving BHT and 11.2% of BNT patients had a good neurological outcome (P < 0.05). Multivariate analysis of patient characteristics revealed relative improvements in patients with an arrest time of less than 20 min and Glasgow Coma Scale (GCS) score greater than 5. There were 19 patients in the BHT group who fulfilled these characteristics, and 73.8% of them had a good neurological outcome, which was significantly higher than the overall percentage of 47.2% (P < 0.05). Brain hypothermic therapy improved the 1-month neurological outcome in patients with an arrest time of less than 20 min and a GCS score greater than 5.

Brain Hypothermic Therapy Following Cardiopulmonary Bypass for Cardiac Arrest Patients Who Did Not Respond to Advanced Cardiovascular Life Support

Cardiac arrest patients who do not respond to advanced cardiovascular life support (ACLS) have a poor neurological outcome. However, some patients obtain good neurological recovery with a cardiac support device. We sought to determine the usefulness of brain hypothermic therapy (BHT) following cardiopulmonary bypass (CPB) in intractable cardiac arrest patients. We performed a retrospective cohort review of cardiac arrest patients with CPB who could not respond to ACLS between 1999 and 2003 in the emergency department. We have carried out BHT (34°C, 2 or 3 days) following CPB in patients who conformed to the following inclusion criteria: (1) their cardiac arrest was witnessed; (2) there was a failure to respond to ACLS; (3) successful intervention for original cause of cardiac arrest was performed; (4) circulation was stabilized following intervention. We evaluated their ECG on admission [ventricular fibrillation (VF) or non-VF] and neurological outcome [dead, vegetative state, severe disability (SD), moderate disability (MD), good recovery (GR)] as measured by the 1-month Glasgow outcome scale (GOS). Resuscitation with CPB was attempted in 30 patients (average age 52 years; 26 men, 4 women), and successfully achieved in 17 of them (57%). Eight of 15 patients who received BHT following CPB (53%) obtained a good neurological outcome (MD and GR), and 3 (20%) died during BHT. Nine of 24 patients who were VF on admission obtained a good neurological outcome (MD and GR: 38%). Six patients were non-VF, and none of them could be resuscitated. We concluded that BHT following CPB is useful for cardiac arrest patients with VF who do not respond to ACLS.