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Article ; Online: Blood pressure augmentation after cardiac arrest: Time to move beyond manipulating vital signs.

Thiara, Sharanjit / Sekhon, Mypinder S

2023 Volume 190, Page(s) 109913

MeSH term(s)	Humans ; Blood Pressure ; Heart Arrest ; Vital Signs/physiology
Language	English
Publishing date	2023-07-27
Publishing country	Ireland
Document type	Editorial ; Research Support, Non-U.S. Gov't ; Comment
ZDB-ID	189901-6
ISSN	1873-1570 ; 0300-9572
ISSN (online)	1873-1570
ISSN	0300-9572
DOI	10.1016/j.resuscitation.2023.109913
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Zs.A 1048: Show issues

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Article ; Online: Low field magnetic resonance imaging: A "beds-eye-d" view into hypoxic ischemic brain injury after cardiac arrest.

Sekhon, Mypinder S / Griesdale, Donald E

Resuscitation

2022 Volume 176, Page(s) 55–57

MeSH term(s)	Brain/pathology ; Brain Injuries ; Heart Arrest/etiology ; Heart Arrest/therapy ; Humans ; Hypoxia-Ischemia, Brain/diagnostic imaging ; Hypoxia-Ischemia, Brain/etiology ; Magnetic Resonance Imaging ; Magnetic Resonance Spectroscopy
Language	English
Publishing date	2022-05-20
Publishing country	Ireland
Document type	Editorial ; Research Support, Non-U.S. Gov't ; Comment
ZDB-ID	189901-6
ISSN	1873-1570 ; 0300-9572
ISSN (online)	1873-1570
ISSN	0300-9572
DOI	10.1016/j.resuscitation.2022.05.010
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Article ; Online: Wolf Creek XVII Part 8: Neuroprotection.

Hirsch, Karen G / Tamura, Tomoyoshi / Ristagno, Giuseppe / Sekhon, Mypinder S

Resuscitation plus

2024 Volume 17, Page(s) 100556

Abstract: Introduction: Post-cardiac arrest brain injury (PCABI) is the primary determinant of clinical outcomes for patients who achieve return of spontaneous circulation after cardiac arrest (CA). There are limited neuroprotective therapies available to ... ...

Abstract	Introduction: Post-cardiac arrest brain injury (PCABI) is the primary determinant of clinical outcomes for patients who achieve return of spontaneous circulation after cardiac arrest (CA). There are limited neuroprotective therapies available to mitigate the acute pathophysiology of PCABI. Methods: Neuroprotection was one of six focus topics for the Wolf Creek XVII Conference held on June 14-17, 2023 in Ann Arbor, Michigan, USA. Conference invitees included international thought leaders and scientists in the field of CA resuscitation from academia and industry. Participants submitted via online survey knowledge gaps, barriers to translation, and research priorities for each focus topic. Expert panels used the survey results and their own perspectives and insights to create and present a preliminary unranked list for each category that was debated, revised and ranked by all attendees to identify the top 5 for each category. Results: Top 5 knowledge gaps included developing therapies for neuroprotection; improving understanding of the pathophysiology, mechanisms, and natural history of PCABI; deploying precision medicine approaches; optimizing resuscitation and CPR quality; and determining optimal timing for and duration of interventions. Top 5 barriers to translation included patient heterogeneity; nihilism & lack of knowledge about cardiac arrest; challenges with the translational pipeline; absence of mechanistic biomarkers; and inaccurate neuro-triage and neuroprognostication. Top 5 research priorities focused on translational research and trial optimization; addressing patient heterogeneity and individualized interventions; improving understanding of pathophysiology and mechanisms; developing mechanistic and outcome biomarkers across post-CA time course; and improving implementation of science and technology. Conclusion: This overview can serve as a guide to transform the care and outcome of patients with PCABI. Addressing these topics has the potential to improve both research and clinical care in the field of neuroprotection for PCABI.
Language	English
Publishing date	2024-02-01
Publishing country	Netherlands
Document type	Journal Article ; Review
ISSN	2666-5204
ISSN (online)	2666-5204
DOI	10.1016/j.resplu.2024.100556
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Article ; Online: Impact of Skin Pigmentation on Cerebral Regional Saturation of Oxygen Using Near-Infrared Spectroscopy: A Systematic Review.

Patel, Nikunj A / Bhattal, Harvir S / Griesdale, Donald E / Hoiland, Ryan L / Sekhon, Mypinder S

Critical care explorations

2024 Volume 6, Issue 2, Page(s) e1049

Abstract: Objectives: Near-infrared spectroscopy (NIRS) is used in critical care settings to measure regional cerebral tissue oxygenation (rSo: Data sources: We systematically searched MEDLINE, Cochrane Database of Systematic Reviews, Embase, and Google ... ...

Abstract	Objectives: Near-infrared spectroscopy (NIRS) is used in critical care settings to measure regional cerebral tissue oxygenation (rSo Data sources: We systematically searched MEDLINE, Cochrane Database of Systematic Reviews, Embase, and Google Scholar from inception to July 1, 2023. Study selection: In compliance with our PROSPERO registration (CRD42022347548), we selected articles comparing rSo Data extraction: We extracted data on self-reported race or level of skin pigmentation and mean rSo Data synthesis: Of the 11,495 unique records screened, two studies ( Conclusions: Skin pigmentation likely results in attenuated rSo
Language	English
Publishing date	2024-02-12
Publishing country	United States
Document type	Journal Article ; Review
ISSN	2639-8028
ISSN (online)	2639-8028
DOI	10.1097/CCE.0000000000001049
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Article ; Online: Shining a light on cerebral autoregulation: Are we anywhere near the truth?

Bird, Jordan D / MacLeod, David B / Griesdale, Donald E / Sekhon, Mypinder S / Hoiland, Ryan L

Journal of cerebral blood flow and metabolism : official journal of the International Society of Cerebral Blood Flow and Metabolism

2024 , Page(s) 271678X241245488

Abstract: The near-infrared spectroscopy (NIRS)-derived cerebral oximetry index (COx) has become popularized for non-invasive neuromonitoring of cerebrovascular function in post-cardiac arrest patients with hypoxic-ischemic brain injury (HIBI). We provide ... ...

Abstract	The near-infrared spectroscopy (NIRS)-derived cerebral oximetry index (COx) has become popularized for non-invasive neuromonitoring of cerebrovascular function in post-cardiac arrest patients with hypoxic-ischemic brain injury (HIBI). We provide commentary on the physiologic underpinnings and assumptions of NIRS and the COx, potential confounds in the context of HIBI, and the implications for the assessment of cerebral autoregulation.
Language	English
Publishing date	2024-04-11
Publishing country	United States
Document type	Journal Article
ZDB-ID	604628-9
ISSN	1559-7016 ; 0271-678X
ISSN (online)	1559-7016
ISSN	0271-678X
DOI	10.1177/0271678X241245488
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Zs.A 1663: Show issues

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Article ; Online: Cerebral hemodynamics after cardiac arrest: implications for clinical management.

Schoenthal, Tison / Hoiland, Ryan / Griesdale, Donald E / Sekhon, Mypinder S

Minerva anestesiologica

2023 Volume 89, Issue 9, Page(s) 824–833

Abstract: Following resuscitation from cardiac arrest, hypoxic ischemic brain injury (HIBI) ensues, which is the primary determinant of adverse outcome. The pathophysiology of HIBI can be compartmentalized into primary and secondary injury, resulting from cerebral ...

Abstract	Following resuscitation from cardiac arrest, hypoxic ischemic brain injury (HIBI) ensues, which is the primary determinant of adverse outcome. The pathophysiology of HIBI can be compartmentalized into primary and secondary injury, resulting from cerebral ischemia during cardiac arrest and reperfusion following successful resuscitation, respectively. During the secondary injury phase, increased attention has been directed towards the optimization of cerebral oxygen delivery to prevent additive injury to the brain. During this phase, cerebral hemodynamics are characterized by early hyperemia following resuscitation and then a protracted phase of cerebral hypoperfusion termed "no-reflow" during which additional hypoxic-ischemic injury can occur. As such, identification of therapeutic strategies to optimize cerebral delivery of oxygen is at the forefront of HIBI research. Unfortunately, randomized control trials investigating the manipulation of arterial carbon dioxide tension and mean arterial pressure augmentation as methods to potentially improve cerebral oxygen delivery have shown no impact on clinical outcomes. Emerging literature suggests differential patient-specific phenotypes may exist in patients with HIBI. The potential to personalize therapeutic strategies in the critical care setting based upon patient-specific pathophysiology presents an attractive strategy to improve HIBI outcomes. Herein, we review the cerebral hemodynamic pathophysiology of HIBI, discuss patient phenotypes as it pertains to personalizing care, as well as suggest future directions.
MeSH term(s)	Humans ; Heart Arrest/therapy ; Brain ; Critical Care ; Hemodynamics ; Oxygen
Chemical Substances	Oxygen (S88TT14065)
Language	English
Publishing date	2023-05-04
Publishing country	Italy
Document type	Review ; Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	123584-9
ISSN	1827-1596 ; 0026-4717 ; 0375-9393
ISSN (online)	1827-1596
ISSN	0026-4717 ; 0375-9393
DOI	10.23736/S0375-9393.23.17268-3
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Zs.A 516: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular Jg. 1995 - 2021: Lesesall (1.OG) ab Jg. 2022: Lesesaal (EG)
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Article ; Online: Correspondence to: Elevated jugular venous oxygen saturation after cardiac arrest.

Griesdale, Donald E G / Sekhon, Mypinder S

Resuscitation

2022 Volume 170, Page(s) 367–368

MeSH term(s)	Heart Arrest/therapy ; Humans ; Oximetry ; Oxygen Saturation
Language	English
Publishing date	2022-02-02
Publishing country	Ireland
Document type	Letter ; Research Support, Non-U.S. Gov't ; Comment
ZDB-ID	189901-6
ISSN	1873-1570 ; 0300-9572
ISSN (online)	1873-1570
ISSN	0300-9572
DOI	10.1016/j.resuscitation.2021.11.042
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Zs.A 1048: Show issues

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Article ; Online: High-normal versus low-normal mean arterial pressure thresholds in critically ill patients: a systematic review and meta-analysis of randomized trials.

Rikhraj, Kiran J K / Ronsley, Claire / Sekhon, Mypinder S / Mitra, Anish R / Griesdale, Donald E G

Canadian journal of anaesthesia = Journal canadien d'anesthesie

2023 Volume 70, Issue 7, Page(s) 1244–1254

Abstract: Purpose: Targeted blood pressure thresholds remain unclear in critically ill patients. Two prior systematic reviews have not shown differences in mortality with a high mean arterial pressure (MAP) threshold, but there have been new studies published ... ...

Title translation	Seuils de pression artérielle moyenne normale à élevée par rapport à normale à faible chez la patientèle gravement malade : revue systématique et méta-analyse d’études randomisées.
Abstract	Purpose: Targeted blood pressure thresholds remain unclear in critically ill patients. Two prior systematic reviews have not shown differences in mortality with a high mean arterial pressure (MAP) threshold, but there have been new studies published since. Thus, we conducted an updated systematic review and meta-analysis of randomized controlled trials (RCTs) that compared the effect of a high-normal vs low-normal MAP on mortality, favourable neurologic outcome, need for renal replacement therapy, and adverse vasopressor-induced events in critically ill patients. Source: We searched six databases from inception until 1 October 2022 for RCTs of critically ill patients targeted to either a high-normal vs a low-normal MAP threshold for at least 24 hr. We assessed study quality using the revised Cochrane risk-of-bias 2 tool and the risk ratio (RR) was used as the summary measure of association. We used the Grading of Recommendations Assessment, Development, and Evaluation framework to assess the certainty of evidence. Principal findings: We included eight RCTs with 4,561 patients. Four trials were conducted in patients following out-of-hospital cardiac arrest, two in patients with distributive shock requiring vasopressors, one in patients with septic shock, and one in patients with hepatorenal syndrome. The pooled RRs for mortality (eight RCTs; 4,439 patients) and favourable neurologic outcome (four RCTs; 1,065 patients) were 1.06 (95% confidence interval [CI], 0.99 to 1.14; moderate certainty) and 0.99 (95% CI, 0.90 to 1.08; moderate certainty), respectively. The RR for the need for renal replacement therapy (four RCTs; 4,071 patients) was 0.97 (95% CI, 0.87 to 1.08; moderate certainty). There was no statistical between-study heterogeneity across all outcomes. Conclusion: This updated systematic review and meta-analysis of RCTs found no differences in mortality, favourable neurologic outcome, or the need for renal replacement therapy between critically ill patients assigned to a high-normal vs low-normal MAP target. Study registration: PROSPERO (CRD42022307601); registered 28 February 2022.
MeSH term(s)	Humans ; Critical Illness ; Arterial Pressure ; Randomized Controlled Trials as Topic ; Bias
Language	English
Publishing date	2023-06-02
Publishing country	United States
Document type	Meta-Analysis ; Systematic Review ; Journal Article ; Review
ZDB-ID	91002-8
ISSN	1496-8975 ; 0832-610X
ISSN (online)	1496-8975
ISSN	0832-610X
DOI	10.1007/s12630-023-02494-3
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Zs.A 109: Show issues

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Article ; Online: Clinical targeting of the cerebral oxygen cascade to improve brain oxygenation in patients with hypoxic-ischaemic brain injury after cardiac arrest.

Hoiland, Ryan L / Robba, Chiara / Menon, David K / Citerio, Giuseppe / Sandroni, Claudio / Sekhon, Mypinder S

Intensive care medicine

2023 Volume 49, Issue 9, Page(s) 1062–1078

Abstract: The cerebral oxygen cascade includes three key stages: (a) convective oxygen delivery representing the bulk flow of oxygen to the cerebral vascular bed; (b) diffusion of oxygen from the blood into brain tissue; and (c) cellular utilisation of oxygen for ... ...

Abstract	The cerebral oxygen cascade includes three key stages: (a) convective oxygen delivery representing the bulk flow of oxygen to the cerebral vascular bed; (b) diffusion of oxygen from the blood into brain tissue; and (c) cellular utilisation of oxygen for aerobic metabolism. All three stages may become dysfunctional after resuscitation from cardiac arrest and contribute to hypoxic-ischaemic brain injury (HIBI). Improving convective cerebral oxygen delivery by optimising cerebral blood flow has been widely investigated as a strategy to mitigate HIBI. However, clinical trials aimed at optimising convective oxygen delivery have yielded neutral results. Advances in the understanding of HIBI pathophysiology suggest that impairments in the stages of the oxygen cascade pertaining to oxygen diffusion and cellular utilisation of oxygen should also be considered in identifying therapeutic strategies for the clinical management of HIBI patients. Culprit mechanisms for these impairments may include a widening of the diffusion barrier due to peri-vascular oedema and mitochondrial dysfunction. An integrated approach encompassing both intra-parenchymal and non-invasive neuromonitoring techniques may aid in detecting pathophysiologic changes in the oxygen cascade and enable patient-specific management aimed at reducing the severity of HIBI.
MeSH term(s)	Humans ; Oxygen ; Brain ; Hypoxia-Ischemia, Brain/therapy ; Heart Arrest/complications ; Heart Arrest/therapy ; Cerebrovascular Circulation/physiology ; Brain Injuries/metabolism
Chemical Substances	Oxygen (S88TT14065)
Language	English
Publishing date	2023-07-28
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	80387-x
ISSN	1432-1238 ; 0340-0964 ; 0342-4642 ; 0935-1701
ISSN (online)	1432-1238
ISSN	0340-0964 ; 0342-4642 ; 0935-1701
DOI	10.1007/s00134-023-07165-x
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Article ; Online: The importance of the oxygen cascade after cardiac arrest.

Sekhon, Mypinder S / Hoiland, Ryan L / Griesdale, Donald E

Resuscitation

2021 Volume 168, Page(s) 231–233

MeSH term(s)	Cardiopulmonary Resuscitation ; Heart Arrest/therapy ; Humans ; Oxygen
Chemical Substances	Oxygen (S88TT14065)
Language	English
Publishing date	2021-09-27
Publishing country	Ireland
Document type	Editorial ; Research Support, Non-U.S. Gov't ; Comment
ZDB-ID	189901-6
ISSN	1873-1570 ; 0300-9572
ISSN (online)	1873-1570
ISSN	0300-9572
DOI	10.1016/j.resuscitation.2021.09.017
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