Application of high-quality targeted temperature management guided by multimodal brain monitoring in brain protection of patients with cardiac arrest: A case series

Abstract

Rationale: Cardiac arrest (CA) is an acute emergency with high mortality and is closely associated with the risk of brain damage or systemic ischemia-reperfusion injury, post-traumatic stress symptoms.

Patient concerns: Targeted temperature management in the intensive care unit can improve the neurological outcomes of patients who are comatose after resuscitation from CA. However, there is often a lack of specific evaluation methods for optimal target temperature settings.

Diagnoses: From November 2021 to October 2022, 9 CA patients received prompt cardiopulmonary resuscitation and return of spontaneous circulation after approximately 10 to 30 minutes of cardiopulmonary resuscitation in Xiangya Hospital, Central South University.

Interventions: We retrospectively reviewed 9 CA patients' medical data, including demographic characteristics, hemodynamic change, clinically relevant score, imageological examination, transcranial Doppler ultrasonography, electroencephalogram (EEG), somatosensory-evoked potential, and laboratory data.

Outcomes: According to the result of each patient's transcranial Doppler ultrasonography, somatosensory-evoked potential, and EEG to formulate an individualized target temperature. Contrary to the internationally recommended target of hypothermia, we found that not all patients require hypothermia therapy to maintain normal cerebrovascular autonomic regulation function. And neuron-specific enolase and S100β in patients showed a downward trend after hypothermia therapy. Compared with before hypothermia treatment, clinically relevant scores were reduced in patients with good prognosis. Intracranial congestion or ischemia was improved and intracranial pressure was reduced in all patients during hypothermia treatment. For patients with good EEG response, the ratio of gray matter in the brain increased and the neurological prognosis was significantly improved. Finally, after 6 months of follow-up, we found 3 patients died and 1 patient had a long-term vegetative state, the other patients had a good prognosis.

Lessons: Individualized targeted temperature management under the guidance of multimodal brain monitoring plays an important role in brain protection of patients with CA.