Pharmacologic neuroprotection in ischemic brain injury after cardiac arrest,Annals of the New York Academy of Sciences

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Pharmacologic neuroprotection in ischemic brain injury after cardiac arrest
Annals of the New York Academy of Sciences ( IF 4.1 ) Pub Date : 2021-05-31 , DOI: 10.1111/nyas.14613
Alyson Katz ₁ , Shari B Brosnahan ₂ , John Papadopoulos ₁ , Sam Parnia ₂ , Jason Q Lam ₃

Affiliation

Cardiac arrest has many implications for morbidity and mortality. Few interventions have been shown to improve return of spontaneous circulation (ROSC) and long-term outcomes after cardiac arrest. Ischemic-reperfusion injury upon achieving ROSC creates an imbalance between oxygen supply and demand. Multiple events occur in the postcardiac arrest period, including excitotoxicity, mitochondrial dysfunction, and oxidative stress and inflammation, all of which contribute to ongoing brain injury and cellular death. Given that complex pathophysiology underlies global brain hypoxic ischemia, neuroprotective strategies targeting multiple stages of the neuropathologic cascade should be considered as a means of mitigating secondary neuronal injury and improving neurologic outcomes and survival in cardiac arrest victims. In this review article, we discuss a number of different pharmacologic agents that may have a potential role in targeting these injurious pathways following cardiac arrest. Pharmacologic therapies most relevant for discussion currently include memantine, perampanel, magnesium, propofol, thiamine, methylene blue, vitamin C, vitamin E, coenzyme Q₁₀, minocycline, steroids, and aspirin.

中文翻译：

心脏骤停后缺血性脑损伤的药物神经保护作用

心脏骤停对发病率和死亡率有很多影响。很少有干预措施可以改善心脏骤停后自主循环 (ROSC) 的恢复和长期预后。达到 ROSC 后的缺血再灌注损伤会导致氧气供需失衡。在心脏骤停后期间会发生多种事件，包括兴奋性毒性、线粒体功能障碍、氧化应激和炎症，所有这些都会导致持续的脑损伤和细胞死亡。鉴于复杂的病理生理学是全球脑缺氧缺血的基础，针对神经病理学级联反应的多个阶段的神经保护策略应被视为减轻继发性神经元损伤和改善心脏骤停患者神经系统预后和生存的一种手段。在这篇评论文章中，我们讨论了许多不同的药物，这些药物可能在心脏骤停后靶向这些有害途径方面发挥潜在作用。目前与讨论最相关的药物疗法包括美金刚、吡仑帕奈、镁、丙泊酚、硫胺素、亚甲蓝、维生素 C、维生素 E、辅酶 Q₁₀、米诺环素、类固醇和阿司匹林。

更新日期：2021-05-31

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