Gul S S, Huesgen K W, Wang K K, Mark K, Tyndall J A
Department of Emergency Medicine, University of Florida, 1329, SW 16th Street, Suite 5270, Gainesville, FL 32608, United States.
Program for Neurotrauma, Neuroproteomics & Biomarker Research, Department of Psychiatry, McKnight Brain Institute, University of Florida, 1149 Newell Drive, Gainesville, FL 32610, United States.
Med Hypotheses. 2017 Aug;105:34-47. doi: 10.1016/j.mehy.2017.06.016. Epub 2017 Jun 24.
Despite aggressive intervention, patients who survive an out-of-hospital cardiac arrest (OHCA) generally have very poor prognoses, with nationwide survival rates of approximately 10-20%. Approximately 90% of survivors will have moderate to severe neurological injury ranging from moderate cognitive impairment to brain death. Currently, few early prognostic indicators are considered reliable enough to support patients' families and clinicians' in their decisions regarding medical futility. Blood biomarkers of neurological injury after OHCA may be of prognostic value in these cases. When most bodily tissues are oxygen-deprived, cellular metabolism switches from aerobic to anaerobic respiration. Neurons are a notable exception, however, being dependent solely upon aerobic respiration. Thus, after several minutes without circulating oxygen, neurons sustain irreversible damage, and certain measurable biomarkers are released into the circulation. Prior studies have demonstrated value in blood biomarkers in prediction of survival and neurologic impairment after OHCA. We hypothesize that understanding peptide biomarker kinetics in the early return of spontaneous circulation (ROSC) period, especially in the setting of refractory cardiac arrest, may assist clinicians in determining prognosis earlier in acute resuscitation. Specifically, during and after immediate resuscitation and return of ROSC, clinicians and families face a series of important questions regarding patient prognosis, futility of care and allocation of scarce resources such as the early initiation of extracorporeal cardiopulmonary resuscitation (ECPR). The ability to provide early prognostic information in this setting is highly valuable. Currently available, as well as potential biomarkers that could be good candidates in prognostication of neurological outcomes after OHCA or in the setting of refractory cardiac arrest will be reviewed and discussed.
尽管采取了积极的干预措施，但院外心脏骤停（OHCA）幸存者的预后通常很差，全国生存率约为10%-20%。约90%的幸存者会有中度至重度神经损伤，范围从中度认知障碍到脑死亡。目前，几乎没有早期预后指标被认为足够可靠，以支持患者家属和临床医生做出关于医疗无效性的决定。OHCA后神经损伤的血液生物标志物在这些情况下可能具有预后价值。当大多数身体组织缺氧时，细胞代谢从有氧呼吸转变为无氧呼吸。然而，神经元是一个显著的例外，它仅依赖有氧呼吸。因此，在几分钟没有循环氧气后，神经元会遭受不可逆的损伤，并且某些可测量的生物标志物会释放到循环中。先前的研究已经证明血液生物标志物在预测OHCA后的生存和神经损伤方面具有价值。我们假设，了解自发循环恢复（ROSC）早期阶段，特别是在难治性心脏骤停情况下的肽生物标志物动力学，可能有助于临床医生在急性复苏早期确定预后。具体而言，在立即复苏和ROSC恢复期间及之后，临床医生和家属面临一系列关于患者预后、护理无效性以及稀缺资源分配（如早期启动体外心肺复苏（ECPR））的重要问题。在这种情况下提供早期预后信息的能力非常有价值。本文将对目前可用的以及可能成为OHCA后神经学结果预后或难治性心脏骤停情况下良好候选指标的潜在生物标志物进行综述和讨论。
