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A PET study of regional cerebral blood flow after experimental cardiopulmonary resuscitation
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Radiology, Oncology and Radiation Science, Section of Nuclear Medicine and PET.
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2007 (English)In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 75, no 1, 98-104 p.Article in journal (Refereed) Published
Abstract [en]

Cerebral blood flow (CBF) during cardiopulmonary resuscitation and after restoration of spontaneous circulation (ROSC) from cardiac arrest has previously been measured with the microspheres and laser Doppler techniques. We used positron emission tomography (PET) with [15O]--water to map the haemodynamic changes after ROSC in nine young pigs. After the baseline PET recording, ventricular fibrillation of 5 min duration was induced, followed by closed-chest cardiopulmonary resuscitation (CPR) in conjunction with IV administration of three bolus doses of adrenaline (epinephrine). After CPR, external defibrillatory shocks were applied to achieve ROSC. CBF was measured at intervals during 4h after ROSC. Relative to the mean global CBF at baseline (32+/-5 ml hg(-1)min(-1)), there was a substantial global increase in CBF at 10 min, especially in the diencephalon. This was followed by an interval of cortical hypoperfusion and a subsequent gradual return to baseline values.

Place, publisher, year, edition, pages
2007. Vol. 75, no 1, 98-104 p.
Keyword [en]
Cardiac arrest, Cardiopulmonary resuscitation (CPR), Cerebral blood flow, Positron emission tomography (PET), Restoration of spontaneous circulation (ROSC)
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:uu:diva-89231DOI: 10.1016/j.resuscitation.2007.03.020ISI: 000250265300014PubMedID: 17499906OAI: oai:DiVA.org:uu-89231DiVA: diva2:159657
Available from: 2009-02-09 Created: 2009-02-09 Last updated: 2015-06-08Bibliographically approved
In thesis
1. Assessment of the Cerebral Ischemic/Reperfusion Injury after Cardiac Arrest
Open this publication in new window or tab >>Assessment of the Cerebral Ischemic/Reperfusion Injury after Cardiac Arrest
2010 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The cerebral damage after cardiac arrest is thought to arise both from the ischemia during the cardiac arrest but also during reperfusion. It is the degree of cerebral damage which determines the outcome in patients. This thesis focuses on the cerebral damage after cardiac arrest.

In two animal studies, positron emission tomography (PET) was used to measure cerebral blood flow, oxygen metabolism and oxygen extraction in the brain. After restoration of spontaneous circulation (ROSC) from five or ten minutes of cardiac arrest there was an immediate hyperperfusion, followed by a hypoperfusion which was most evident in the cortex. The oxygen metabolism decreased after ROSC with the lowest values in the cortex. The oxygen extraction was high at 60 minutes after ROSC, indicating an ischemic situation. After ten minutes of cardiac arrest, there was a hyperperfusion in the cerebellum.

In 31 patients resuscitated after cardiac arrest and treated with hypothermia for 24 hours, blood samples were collected from admission until 108 hours after ROSC. The samples were analyzed for different biomarkers in order to test the predictive value of the biomarkers. The patients were assessed regarding their neurological outcome at discharge from the intensive care unit and after six months. Brain derived neurotrophic factor (BDNF) and glial fibrillary acidic protein (GFAP) was not associated with outcome. Neuron specific enolase (NSE) concentrations were higher among those with a poor outcome with a sensitivity of 57% and a specificity of 93% when sampled 96 hours after ROSC. S-100B was very accurate in predicting outcome; after 24 hours after ROSC it predicted a poor outcome with a sensitivity of 87% and a specificity of 100%. Tau protein predicted a poor outcome after 96 hours after ROSC with a sensitivity of 71% and a specificity of 93%.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2010. 71 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 615
National Category
Anesthesiology and Intensive Care
Research subject
Anaesthesiology and Intensive Care
Identifiers
urn:nbn:se:uu:diva-132681 (URN)978-91-554-7932-9 (ISBN)
Public defence
2010-12-10, Grönwallsalen, Akademiska sjukhuset, entrance 70, Uppsala, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2010-11-18 Created: 2010-10-25 Last updated: 2011-01-13Bibliographically approved

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Mörtberg, ErikWiklund, LarsWall, AndersRubertsson, Sten

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