Cardiac arrest-neuroprotection

 Principal investigator: Sten Rubertsson

​Hypothermia treatment in cardiac arrest patients

Hypothermia treatment to 32-34 °C during 24 hours after cardiac arrest has been shown to improve survival and neurologic outcome. Fifty percent of the admitted patients treated by hypothermia are now surviving. Hypothermia after global ischemia in cardiac arrest patients can be induced with both invasive and noninvasive methods with varying efficiency. Since there is a risk for side effects and complications with systemic hypothermia, a more selective cooling of the brain might be an alternative in treatment of global or focal ischemic brain injury after cardiac arrest trauma or stroke. We have together with researchers from Lund University developed a new intranasal cooling method using balloon catheters introduced into the nasopharynx with cold saline solution circulated in a closed circuit with a pump and heater exchanger. Different methods have been used for early prognostification in the effort to improve treatment. Markers of brain injury that have been investigated in cardiac arrest patients treated with hypothermia are S-100β (astroglial protein) och NSE (neuronspecific enolas). Continous EEG registration of patients during and after hypothermia treatment is of prognostic value in one study. EEG will also detect epileptic activity requiring treatment. For the cardiac arrest patient not only survival is of major importance but also how quality life will be affected.

Questions: Will this new intranasal cooling method be clinically feasible in patients together with infusion of cold saline i v to effectively cool the brain and body after cardiac arrest and maybe also in the future patients with stroke or traumatic brain injury? The aim is also to follow-up patients during the first 6 months after cardiac arrest treated by hypothermia and study quality of life, physical and psychological function, neurologic function and mortality in relation to initial levels of markers of brain injury. Finally, the aim is to describe the influence on relative’s daily life.

Methods and results: Experimental studies have shown that the brain will be selectively cooled during normal circulation. In both experimental and clinical studies we have shown that brain temperature will decrease measured by MR spectroscopy. This technique will now undergo testing for feasibility in pilot studies of patients after cardiac arrest. Markers of brain injury are sampled directly after the patient is admitted to hospital and followed up to 108 hrs after cardiac arrest. MRI of the brain is done five days after the cardiac arrest and EEG will be monitored up to 48 hrs after cardiac arrest. Follow-up of the patients will be performed at discharge from the hospital one and sex months after the cardiac arrest. Next of kin will be interviewed first when the patient is discharged from hospital and at sex months after the injury.

Members of the group in 2013
Sten Rubertsson, Professor
Erik Mörtberg, MD, PhD
Lucian Covaciu, MD, PhD student
Erik Lindgren, MD, PhD student
Ing-Marie Larsson, RN, PhD student
Eva C Wallin, RN, PhD student
Marja Leena Kristofferzon, RN, PhD Senior Registrar Gävle University
Marie Sellert-Rydberg, RN Falu Hospital

In collaboration with
Håkan Ahlström, Professor Dept. of Radiology
Jan Weis, Engineer, Associate Professor Dept. of Radiology

Mechanical chest compressions during cardiac arrest

Background: Every year 300 000 to 400 000 people suffer from sudden cardiac arrest outside of the hospital in Europe. Only 5-9 % of these patients survives and is discharged from hospital. Lately, there is a strong emphasis on chest compressions being delivered without interruptions. Manual chest compressions during CPR result in only 20-30% of normal blood flow and are difficult to perform continuously. Mechanical chest compressions with the LUCAS device have shown increased cerebral blood flow, coronary perfusion pressure and survival in experimental studies.

Questions: Can mechanical chest compressions with the LUCAS device combined with defibrillation during ongoing chest compressions improve survival? Will treatment with the LUCAS device result in more injuries in non surviving patients.

Methods and results: Defibrillation during ongoing mechanical compressions showed promising results with a trend in increased short time survival in out of hospital cardiac arrest in a recently completed pilot study of 149 patients. Autopsy was performed in 85 non surviving patients after being treated with either mechanical chest compressions with the LUCAS device or with manual chest compressions according to guidelines. There were no injuries in one third of the patients in both groups. The most frequent injuries found were rib fractures and sternal fractures but there was no difference between the groups. No fatal injuries were found in any of the groups. The results from this pilot studies are the foundation for a multicenter study in Europe-the LINC study of 2 500 patients with out-of hospital cardiac arrest. The study started in January 2008 and will continue to 2012. Patients with cardiac arrest will be randomized to either treatment with a concept using mechanical chest compressions with the LUCAS and defibrillation during ongoing compressions or treatment according to international guidelines including manual chest compressions. In January 2011, an interimanalysis will be performed to allow inclusion of the entire study population. Within this study, non surviving patients in Uppsala, Gävle and Västerås will undergo autopsy.

Members of the group during 2013
Sten Rubertson, Professor
Jakob Johansson, MD, PhD
David Smekal, MD, PhD student
Erik Lindgren, MD, PhD student

In collaboration with
Steering com for the LINC trial