Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy.
Vita-Salute San Raffaele University, Milan, Italy.
Neurocrit Care. 2018 Jun;28(3):370-378. doi: 10.1007/s12028-017-0445-0.
Cardiac arrest is an important cause of morbidity and mortality. Brain injury severity and prognosis of cardiac arrest patients are related to the cerebral areas affected. To this aim, we evaluated the variability and the distribution of brain glucose metabolism after cardiac arrest and resuscitation in an adult rat model.
Ten rats underwent 8-min cardiac arrest, induced with a mixture of potassium and esmolol, and resuscitation, performed with chest compressions and epinephrine. Eight sham animals received anesthesia and experimental procedures identical to the ischemic group except cardiac arrest induction. Brain metabolism was assessed using [F]FDG autoradiography and small animal-dedicated positron emission tomography.
The absolute glucose metabolism measured with [F]FDG autoradiography 2 h after cardiac arrest and resuscitation was lower in the frontal, parietal, occipital, and temporal cortices of cardiac arrest animals, showing, respectively, a 36% (p = 0.006), 32% (p = 0.016), 36% (p = 0.009), and 32% (p = 0.013) decrease compared to sham group. Striatum, hippocampus, thalamus, brainstem, and cerebellum showed no significant changes. Relative regional metabolism indicated a redistribution of metabolism from cortical area to brainstem and cerebellum.
Our data suggest that cerebral regions have different susceptibility to moderate global ischemia in terms of glucose metabolism. The neocortex showed a higher sensibility to hypoxia-ischemia than other regions. Other subcortical regions, in particular brainstem and cerebellum, showed no significant change compared to non-ischemic rats.
心脏骤停是发病率和死亡率的重要原因。心脏骤停患者的脑损伤严重程度和预后与受影响的脑区有关。为此，我们评估了成年大鼠模型心脏骤停和复苏后脑葡萄糖代谢的变异性和分布。
10 只大鼠接受 8 分钟的心脏骤停，使用钾和艾司洛尔混合物诱导，并用胸部按压和肾上腺素进行复苏。8 只假手术动物接受麻醉和与缺血组相同的实验程序，除了心脏骤停诱导。使用 [F]FDG 放射自显影和小动物专用正电子发射断层扫描评估脑代谢。
心脏骤停和复苏后 2 小时用 [F]FDG 放射自显影测量的绝对葡萄糖代谢在心脏骤停动物的额、顶、枕和颞皮质中较低，分别下降 36%（p=0.006）、32%（p=0.016）、36%（p=0.009）和 32%（p=0.013）。纹状体、海马体、丘脑、脑干和小脑没有明显变化。相对区域代谢表明代谢从皮质区重新分布到脑干和小脑。
我们的数据表明，大脑区域在葡萄糖代谢方面对中度全脑缺血的敏感性不同。新皮层对缺氧缺血的敏感性高于其他区域。其他皮质下区域，特别是脑干和小脑，与非缺血大鼠相比没有明显变化。
