Skip to main content Accessibility help

We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.

Close cookie message
×
Hostname: page-component-78c5997874-8bhkd Total loading time: 0 Render date: 2024-11-19T05:08:03.194Z Has data issue: false hasContentIssue false

Chapter 31 - Hypoxic Encephalopathy in the Neurocritical Care Unit

Published online by Cambridge University Press:  24 July 2019

By
Maximilian Mulder  and
Romergryko G. Geocadin
Edited by
Michel T. Torbey
Michel T. Torbey
Affiliation:
Ohio State University
Get access

Summary

The term hypoxic encephalopathy (HE) refers to a syndrome of global brain injury resulting from critical reduction or loss of blood flow and supply of oxygen and nutrients to the brain. Synonyms used to describe this clinical entity include hypoxic-ischemic or anoxic encephalopathy and postcardiac-arrest brain injury, among others. Most cases of HE can be attributed to complications during the perinatal period in children, and in adults HE mostly results from cardiac arrest or asphyxia, with approximately half a million cases per year of HE in the United States [1]. Hypoxic encephalopathy is one of the most important and devastating clinical manifestations of the postcardiac-arrest syndrome (PCAS) characterized mainly by postcardiac-arrest brain injury, myocardial dysfunction, and a systemic ischemia-reperfusion response [2]. This chapter will cover the initial postresuscitation care, therapeutic hypothermia, and critical care management, as well as prognostication of neurologic outcomes of hypoxic encephalopathy in adults.

Type
Chapter
Information
Neurocritical Care , pp. 382 - 391
Publisher: Cambridge University Press
Print publication year: 2019

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Go, AS, Mozaffarian, D, Roger, VL, et al. (2013). Heart disease and stroke statistics: 2013 update a report from the American Heart Association. Circulation, 127: e1–e240.Google ScholarPubMed
Neumar, RW, Nolan, JP, Adrie, C, et al. (2008). Post-cardiac arrest syndrome: epidemiology, pathophysiology, treatment, and prognostication: a consensus statement from the International Liaison Committee on Resuscitation. Circulation, 118: 2452–2483.Google Scholar
Peberdy, MA, Callaway, CW, Neumar, RW, et al. (2010). Part 9. Post-cardiac arrest care: 2010 American Heart Association Guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation, 122: S768–S786.Google Scholar
Bernard, SA, Gray, TW, Buist, MD, et al. (2002). Treatment of comatose survivors of out-of-hospital cardiac arrest with induced hypothermia. N Engl J Med, 346: 557–563.Google Scholar
Hypothermia After Cardiac Arrest Group. (2002). Mild therapeutic hypothermia to improve the neurologic outcome after cardiac arrest. N Engl J Med, 346: 549–556.Google Scholar
Nolan, JP, Morley, PT, Vanden Hoek, TL, et al. (2003). Therapeutic hypothermia after cardiac arrest: an advisory statement by the Advanced Life Support Task Force of the International Liaison Committee on Resuscitation. Circulation, 108: 118–121.Google ScholarPubMed
Nielsen, N, Wetterslev, J, Cronberg, T, et al. (2013). Targeted temperature management at 33°C versus 36°C after cardiac arrest. N Engl J Med, 369: 2197–2206.Google Scholar
Ian, J, Nadkarni, V. (2013). Targeted temperature management following cardiac arrest: an update. www.ilcor.org/data/TTM-ILCOR-update-Dec-2013.pdf (accessed December 2018).Google Scholar
Kim, F, Olsufka, M, Longstreth, WT, et al. (2007). Pilot randomized clinical trial of prehospital induction of mild hypothermia in out-of-hospital cardiac arrest patients with a rapid infusion of 4 degrees C normal saline. Circulation, 115: 3064–3070.CrossRefGoogle ScholarPubMed
Bernard, SA, Smith, K, Cameron, P, et al. (2012). Induction of prehospital therapeutic hypothermia after resuscitation from nonventricular fibrillation cardiac arrest. Crit Care Med, 40: 747–753.CrossRefGoogle ScholarPubMed
Kim, F, Nichol, G, Maynard, C, et al. (2013). Effect of prehospital induction of mild hypothermia on survival and neurological status among adults with cardiac arrest: a randomized clinical trial. JAMA, 98104: 1–8.Google Scholar
Sendelbach, S, Hearst, MO, Johnson, PJ, et al. (2012). Effects of variation in temperature management on cerebral performance category scores in patients who received therapeutic hypothermia post cardiac arrest. Resuscitation, 83: 829–834.Google Scholar
Doufas, AG, Lin, C-M, Suleman, M-I, et al. (2003). Dexmedetomidine and meperidine additively reduce the shivering threshold in humans. Stroke, 34: 1218–1223.Google Scholar
Mirski, MA, Lewin, JJ, Ledroux, S, et al. (2010). Cognitive improvement during continuous sedation in critically ill, awake and responsive patients: the Acute Neurological ICU Sedation Trial (ANIST). Intensive Care Med, 36: 1505–1513.CrossRefGoogle Scholar
Schoeler, M, Loetscher, PD, Rossaint, R, et al. (2012). Dexmedetomidine is neuroprotective in an in vitro model for traumatic brain injury. BMC Neurol, 12: 20.Google Scholar
Badjatia, N, Strongilis, E, Gordon, E, et al. (2008). Metabolic impact of shivering during therapeutic temperature modulation: the Bedside Shivering Assessment Scale. Stroke, 39: 3242–3247.Google Scholar
Leary, M, Grossestreuer, A V, Iannacone, S, et al. (2012). Pyrexia and neurologic outcomes after therapeutic hypothermia for cardiac arrest. Resuscitation, 84(8): 1056–1061.Google Scholar
Naples, R, Ellison, E, Brady, WJ. (2009). Cranial computed tomography in the resuscitated patient with cardiac arrest. Am J Emerg Med, 27: 63– 67.Google Scholar
Nordmark, J, Rubertsson, S, Mörtberg, E, et al. (2009). Intracerebral monitoring in comatose patients treated with hypothermia after a cardiac arrest. Acta Anaesthesiol Scand, 53: 289–298.Google Scholar
Koenig, M, Bryan, M, Lewin, J, et al. (2008). Reversal of transtentorial herniation with hypertonic saline. Neurology, 70: 1023–1029.Google Scholar
Rittenberger, JC, Popescu, A, Brenner, RP, et al. (2012). Frequency and timing of nonconvulsive status epilepticus in comatose post-cardiac arrest subjects treated with hypothermia. Neurocrit Care, 16: 114–122.CrossRefGoogle ScholarPubMed
Mani, R, Schmitt, SE, Mazer, M, et al. (2012). The frequency and timing of epileptiform activity on continuous electroencephalogram in comatose post-cardiac arrest syndrome patients treated with therapeutic hypothermia. Resuscitation, 83: 840–847.Google Scholar
Rossetti, AO, Urbano, LA, Delodder, F, et al. (2010). Prognostic value of continuous EEG monitoring during therapeutic hypothermia after cardiac arrest. Crit Care, 14: R173.Google Scholar
Nielsen, N, Sunde, K, Hovdenes, J, et al. (2011). Adverse events and their relation to mortality in out-of-hospital cardiac arrest patients treated with therapeutic hypothermia. Crit Care Med, 39: 57– 64.CrossRefGoogle ScholarPubMed
Bouwes, A, van Poppelen, D, Koelman, JHTM, et al. (2012). Acute posthypoxic myoclonus after cardiopulmonary resuscitation. BMC Neurol, 12: 1–6.Google Scholar
Rossetti, AO, Oddo, M, Logroscino, G, et al. (2010). Prognostication after cardiac arrest and hypothermia: a prospective study. Ann Neurol, 67: 301–307.Google Scholar
Lucas, JM, Cocchi, MN, Salciccioli, J, et al. (2012). Neurologic recovery after therapeutic hypothermia in patients with post-cardiac arrest myoclonus. Resuscitation, 83: 265–269.Google Scholar
Kilgannon, JH, Jones, AE, Shapiro, NI, et al. (2010). Association between arterial hyperoxia following resuscitation from cardiac arrest and in-hospital mortality. JAMA, 303: 2165–2171.Google Scholar
Kilgannon, JH, Jones, AE, Parrillo, JE, et al. (2011). Relationship between supranormal oxygen tension and outcome after resuscitation from cardiac arrest. Circulation, 123: 2717–2722.Google Scholar
Nekludov, M, Bellander, B-M, Mure, M. (2006). Oxygenation and cerebral perfusion pressure improved in the prone position. Acta Anaesthesiol Scand, 50: 932–936.CrossRefGoogle ScholarPubMed
Thelandersson, A, Cider, A, Nellgård, B. (2006). Prone position in mechanically ventilated patients with reduced intracranial compliance. Acta Anaesthesiol Scand, 50: 937–941.Google Scholar
Vrettou, CS, Zakynthinos, SG, Malachias, S, et al. (2013). High-frequency oscillation and tracheal gas insufflation in patients with severe acute respiratory distress syndrome and traumatic brain injury: an interventional physiological study. Crit Care, 17: R136.CrossRefGoogle ScholarPubMed
Gritti, P, Lanterna, LA, Re, M, et al. (2013). The use of inhaled nitric oxide and prone position in an ARDS patient with severe traumatic brain injury during spine stabilization. J Anesth, 27: 293–297.Google Scholar
Marik, PE, Young, A, Sibole, S, et al. (2012). The effect of APRV ventilation on ICP and cerebral hemodynamics. Neurocrit Care, 17: 219–223.Google Scholar
Nemer, SN, Caldeira, JB, Azeredo, LM, et al. (2011). Alveolar recruitment maneuver in patients with subarachnoid hemorrhage and acute respiratory distress syndrome: a comparison of 2 approaches. J Crit Care, 26: 22– 27.Google Scholar
Krag, M, Perner, A, Wetterslev, J, et al. (2013). Stress ulcer prophylaxis in the intensive care unit: is it indicated? A topical systematic review. Acta Anaesthesiol. Scand, 57: 835–847.Google Scholar
Carson, J, Carless, P, Hebert, P. (2012). Transfusion thresholds and other strategies for guiding allogeneic red blood cell transfusion (Review). Cochrane Database Syst Rev, (4): CD002042.Google Scholar
Carson, JL, Grossman, BJ, Kleinman, S, et al. (2012). Clinical guideline red blood cell transfusion: a clinical practice guideline from the AABB. Ann Intern Med, 157: 49– 58.Google Scholar
Wijdicks, EFM, Hijdra, A, Young, GB, et al. (2006). Practice parameter: prediction of outcome in comatose survivors after cardiopulmonary resuscitation (an evidence-based review). A report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology, 67: 203–210.CrossRefGoogle Scholar
Howell, K, Grill, E, Klein, A-M, et al. (2013). Rehabilitation outcome of anoxic-ischaemic encephalopathy survivors with prolonged disorders of consciousness. Resuscitation, 84: 1409–1415.Google Scholar
Samaniego, EA, Mlynash, M, Caulfield, AF, et al. (2011). Sedation confounds outcome prediction in cardiac arrest survivors treated with hypothermia. Neurocrit Care, 15: 113–119.Google Scholar
Cronberg, T, Brizzi, M, Liedholm, LJ, et al. (2013). Neurological prognostication after cardiac arrest--recommendations from the Swedish Resuscitation Council. Resuscitation, 84: 867–872.CrossRefGoogle ScholarPubMed
Bouwes, A, Binnekade, JM, Kuiper, M, et al. (2012). Prognosis of coma after therapeutic hypothermia: a prospective cohort study. Ann Neurol, 71: 206–212.Google Scholar
Al Thenayan, E, Savard, M, Sharpe, M, et al. (2008). Predictors of poor neurologic outcome after induced mild hypothermia following cardiac arrest. Neurology, 71: 1535–1537.Google Scholar
Rittenberger, JC, Sangl, J, Wheeler, M, et al. (2010). Association between clinical examination and outcome after cardiac arrest. Resuscitation, 81: 1128–1132.Google Scholar
Fugate, JE, Wijdicks, EFM, Mandrekar, J, et al. (2010). Predictors of neurologic outcome in hypothermia after cardiac arrest. Ann Neurol, 68: 907–914.Google Scholar
Steffen, IG, Hasper, D, Ploner, CJ, et al. (2010). Mild therapeutic hypothermia alters neuron specific enolase as an outcome predictor after resuscitation: 97 prospective hypothermia patients compared to 133 historical non-hypothermia patients. Crit Care, 14: R69.Google Scholar
Abend, NS, Mani, R, Tschuda, TN, et al. (2012). EEG monitoring during therapeutic hypothermia in neonates, children, and adults. Am J Electroneurodiagnostic Technol, 51: 1–20.Google Scholar
Leithner, C, Ploner, CJ, Hasper, D, et al. (2010). Does hypothermia influence the predictive value of bilateral absent N20 after cardiac arrest? Neurology, 74: 965–969.Google Scholar
Hahn, DK, Geocadin, RG, Greer, DM. (2013). Quality of evidence in studies evaluating neuroimaging for neurologic prognostication in adult patients resuscitated from cardiac arrest. Resuscitation, 85: 165–172.Google Scholar

Save book to Kindle

To save this book to your Kindle, first ensure coreplatform@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×