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Pharmacological Approach for Neuroprotection After Cardiac Arrest-A Narrative Review of Current Therapies and Future Neuroprotective Cocktail.

作者信息

Choudhary Rishabh C, Shoaib Muhammad, Sohnen Samantha, Rolston Daniel M, Jafari Daniel, Miyara Santiago J, Hayashida Kei, Molmenti Ernesto P, Kim Junhwan, Becker Lance B

机构信息

Laboratory for Critical Care Physiology, The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, United States.

Department of Emergency Medicine, Northshore University Hospital, Northwell Health, Manhasset, NY, United States.

出版信息

Front Med (Lausanne). 2021 May 18;8:636651. doi: 10.3389/fmed.2021.636651. eCollection 2021.


DOI:10.3389/fmed.2021.636651
PMID:34084772
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8167895/
Abstract

Cardiac arrest (CA) results in global ischemia-reperfusion injury damaging tissues in the whole body. The landscape of therapeutic interventions in resuscitation medicine has evolved from focusing solely on achieving return of circulation to now exploring options to mitigate brain injury and preserve brain function after CA. CA pathology includes mitochondrial damage and endoplasmic reticulum stress response, increased generation of reactive oxygen species, neuroinflammation, and neuronal excitotoxic death. Current non-pharmacologic therapies, such as therapeutic hypothermia and extracorporeal cardiopulmonary resuscitation, have shown benefits in protecting against ischemic brain injury and improving neurological outcomes post-CA, yet their application is difficult to institute ubiquitously. The current preclinical pharmacopeia to address CA and the resulting brain injury utilizes drugs that often target singular pathways and have been difficult to translate from the bench to the clinic. Furthermore, the limited combination therapies that have been attempted have shown mixed effects in conferring neuroprotection and improving survival post-CA. The global scale of CA damage and its resultant brain injury necessitates the future of CA interventions to simultaneously target multiple pathways and alleviate the hemodynamic, mitochondrial, metabolic, oxidative, and inflammatory processes in the brain. This narrative review seeks to highlight the current field of post-CA neuroprotective pharmaceutical therapies, both singular and combination, and discuss the use of an extensive multi-drug cocktail therapy as a novel approach to treat CA-mediated dysregulation of multiple pathways, enhancing survival, and neuroprotection.

摘要
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0fa2/8167895/94d791030add/fmed-08-636651-g0001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0fa2/8167895/94d791030add/fmed-08-636651-g0001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0fa2/8167895/94d791030add/fmed-08-636651-g0001.jpg

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[3]
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[5]
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[6]
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[7]
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[8]
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[9]
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[10]
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本文引用的文献

[1]
Plasma metabolomics supports the use of long-duration cardiac arrest rodent model to study human disease by demonstrating similar metabolic alterations.

Sci Rep. 2020-11-12

[2]
Effects of ω-3 PUFA and ascorbic acid combination on post-resuscitation myocardial function.

Biomed Pharmacother. 2021-1

[3]
A walk through the progression of resuscitation medicine.

Ann N Y Acad Sci. 2022-1

[4]
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J Inflamm (Lond). 2020-8-5

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J Int Med Res. 2020-5

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J Am Heart Assoc. 2020-5-18

[7]
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Oxid Med Cell Longev. 2020-1-22

[8]
Cannabinoid Receptor Agonist WIN55, 212-2 Adjusts Lipid Metabolism in a Rat Model of Cardiac Arrest.

Ther Hypothermia Temp Manag. 2020-12

[9]
Neuroprotection of Glibenclamide against Brain Injury after Cardiac Arrest via Modulation of NLRP3 Inflammasome.

Annu Int Conf IEEE Eng Med Biol Soc. 2019-7

[10]
Suppression of Superoxide-Hydrogen Peroxide Production at Site IQ of Mitochondrial Complex I Attenuates Myocardial Stunning and Improves Postcardiac Arrest Outcomes.

Crit Care Med. 2020-2

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