Literature Watch

European Journal of Neurology (02/17/20) doi: 10.1111/ene.14178 Fandler‐Höfler, Simon; Heschl, Stefan; Kneihsl, Markus; et al. For stroke patients receiving mechanical thrombectomy (MT), extubation should occur as early as safely possible, Austrian researchers report, citing as association between prolonged ventilation and unfavorable outcome at 3 months and increased rates of pneumonia. Their study involved 447 consecutive ischemic stroke patients who had been treated at their facility with MT for anterior circulation large vessel occlusion under ...

Journal of the American Medical Association (02/20/20) doi: 10.1001/jama.2020.1511 Campbell, Bruce C. V.; Mitchell, Peter J.; Churilov, Leonid; et al. While I.V. thrombolysis with tenecteplase is superior to alteplase in improving cerebral reperfusion in ischemic stroke patients, it was unknown if tenecteplase's performance is influenced by dose. To explore, researchers in Australia and New Zealand assembled a trial population of 300 adults with ischemic stroke caused by large vessel occlusion. Participants in the EXTEND-IA TNK study Part II were ...

Amarenco P, Kim JS, Labreuche H, et al.  A comparison of two LDL cholesterol targets after ischemic stroke.  NEJM 2020; 382:9-19.   Reviewed by Kyle Hobbs, MD Read the article .   Summary :  Intensive lipid lowering therapy is recommended after ischemic stroke or TIA, but the exact LDL target is unclear. The Treat Stroke to Target trial is an international, multicenter, randomized, parallel-group, event driven trial comparing a target LDL of < 70 mg/dL to a target of 90-110 mg/dL after ischemic stroke or TIA in patients with atherosclerosis.  ...

Barletta JF, Abdul-Rahman D, Hall ST, Mangram AJ, Dzandu JK, Frontera JA, Zach V. The role of desmopressin on hematoma expansion in patients with mild traumatic brain injury prescribed pre-injury antiplatelet medications. Neurocritical Care. 2020 Jan 2. doi: 10.1007/s12028-019-00899-x Reviewed by Alexis Steinberg, MD   Read the article .*   *You will need to log in to US National Library of Medicine National Institutes of Health to read this article.     Methods: An increased risk for traumatic intracerebral hemorrhage (ICH) and expansion ...

Annals of Neurology (01/10/20)  doi.org/10.1002/ana.25675 Sharma, Sripadh; Ifergan, Igal; Kurz, Jonathan E.; et al. Immunomodulatory nanoparticles (IMPs) – which ablate a particular subset of hematogenous monocytes – are a strong therapeutic candidate for traumatic brain injury (TBI), new research shows. Researchers from the Northwestern University Feinberg School of Medicine in Chicago administered an intravenous infusion of IMPs containing 500 nm carboxylated‐poly(lactic‐co‐glycolic) acid into wild‐type C57BL/6 mice following controlled cortical ...

Journal of Neurology (01/18/20)  doi: 10.1007/s00415-020-09701-x Fandler-Höfler, Simon; Heschl, Stefan; Argüelles-Delgado, Placido; et al. Declines in mean arterial pressure (MAP) below 60 mmHg during general anesthesia (GA) for stroke patients undergoing mechanical thrombectomy (MT) are independently associated with worse functional outcome three months after the stroke, according to new research. The retrospective cohort study, conducted at a single center in Austria, involved adults who had received MT because of anterior circulation large vessel ...

By Fowler AA, Truwit JD, Hite RD, et al.  Effect of vitamin C infusion on organ failure and biomarkers of inflammation and vascular injury in patients with sepsis and severe acute respiratory failure.  JAMA 2019; 322(13):1261-1270.  Reviewed by: Kyle Hobbs, MD    Read the article .*    *You will need to log in to US National Library of Medicine National Institutes of Health to read this article.     Summary Acute respiratory distress syndrome (ARDS) often accompanies sepsis and contributes to significant morbidity and mortality. This ...

By Sekhon MS, Gooderham P, Menon DK, et al.  The burden of brain hypoxia and optimal mean arterial pressure in patients with hypoxic ischemic brain injury after cardiac arrest.  Crit Care Med 2019; 47(7):960-969. Reviewed by: Kyle Hobbs, MD  Read the article .*  *You will need to log in to US National Library of Medicine National Institutes of Health to read this article.    Summary Secondary injury after cardiac arrest is a major determinant of neurologic outcome and is caused, in part, by a prolonged period of hypoperfusion (“no-reflow”) ...

By Morte D, Lammers D, Bingham J, Kuckelman J, Eckert M, Martin M. Tranexamic acid administration following head trauma in a combat setting: Does tranexamic acid result in improved neurologic outcomes? J Trauma Acute Care Surg. 2019 Jul;87(1):125-129 Reviewed by Wazim Mohamed, MD Read the article .*  *You will need to log in to US National Library of Medicine National Institutes of Health to read this article.    Summary Among trauma related deaths, hemorrhage accounts for approximately 30%, and trauma associated coagulopathy is a ...

By Kyle Hobbs, MD and Sara Stern-Nezer, MD   Coma secondary to acute brain injury is extremely common in the neurocritical care unit, but prognosis after coma is challenging. Electroencephalography provides a window into the comatose brain, revealing brain activity even in the absence of clinical responses. The reviewed studies below investigate the role of EEG in comatose patients.   Electroencephalographic reactivity as predictor of neurologic outcome in postanoxic coma: A multicenter prospective cohort study.  Ann Neurol 2019; 86:17-27   ...

By   Ma, H., Campbell, B.C., Parsons, M.W., et al. New England Journal of Medicine ,  380 (19), pp.1795-1803. Summary Methods: The recently successful thrombectomy trials (DEFUSE 3 and DAWN) have set a paradigm of reperfusion based on tissue viability assessed by perfusion imaging rather than time from symptom onset. However, this has also caused a disparity between the accepted time frame for chemical thrombolysis (up to 4.5 hours) and mechanical thrombectomy (up to 24 hours). This international multicenter phase 3 randomized controlled trial ...

By Harahsheh, Y., Duff, O.C., Ho, K.M. “Thromboelastography predicts thromboembolism in critically ill coagulopathic patients.” CCM. 2019;47(6): 826-832. Summary : Thromboembolism is the main cause of preventable hospital-associated death. Coagulopathy is common in the ICU, often resulting in cessation of venous thromboembolism (VTE) prophylaxis, but some of these patients with abnormal coagulation may remain at high risk of VTE. This prospective cohort aimed to use thromboelastography (TEG) to risk-stratify risk of VTE in coagulopathic patients admitted ...

Authors: Roberts BW, Kilgannon JH, Hunter BR, et al. Association Between Elevated Mean Arterial Blood Pressure and Neurologic Outcome After Resuscitation From Cardiac Arrest: Results From a Multicenter Prospective Cohort Study. CCM. 2019 Jan;47(1):93-100. Reviewed by: Sara Stern-Nezer, MD, MPH; and Kyle Hobbs, MD  Read the article .*  *You will need to log in to US National Library of Medicine National Institutes of Health to read this article.  Even in the era of TTM, a large number of post-cardiac arrest patients have poor outcomes, in part owing ...

Authors: Tsai MS, Chuang PY, et al. Postarrest steroid use may improve outcomes of cardiac arrest survivors. CCM. 2019 Feb;47(2):167-175. Reviewed by: Sara Stern-Nezer, MD, MPH; and Kyle Hobbs, MD  Read the article. * *You will need to log in to US National Library of Medicine National Institutes of Health to read this article.    Even in the era of TTM, a large number of post-cardiac arrest patients have poor outcomes, in part owing to the ongoing secondary brain injury that occurs after ROSC. In these reviews, we consider additional targets ...

Authors: Leslie-Mazwi TM, Hamilton S, et al. DEFUSE 3 Non-DAWN Patients: A Closer Look at Late Window Thrombectomy Selection. Stroke . 2019 Feb 6 :STROKEAHA-118 . Reviewed by: Wazim Mohamed, MD, Assistant Professor of Neurology, Division of Neurotrauma and Critical Care Neurology, Wayne State University Read the article. * *You will need to log in to US National Library of Medicine National Institutes of Health to read this article.  Methods The 2018 American Heart Association guidelines for the management of acute ischemic stroke recommend ...

Authors: Galovic M, Stauber AJ, Leisi N, et al. Development and Validation of a Prognostic Model of Swallowing Recovery and Enteral Tube Feeding After Ischemic Stroke.  JAMA Neurol . Published online February 11, 2019. doi :10.1001/jamaneurol.2018.4858 Reviewed by: Lara L. Zimmermann, MD, Co-Director, Neurocritical Care Service, Assistant Professor of Neurological Surgery and Neurology, UC Davis School of Medicine Read the article. * *You will need to log in to US National Library of Medicine National Institutes of Health to read this article. ...

By Shraddha Mainali, MD, and Paul M. Vespa, MD, FCCM, FAAN, FANA, FNCS Special thanks to Jose Javier Provencio MD, FCCM, FAAN, FNCS; Susanne Muehlschlegel MD, MPH, FNCS, FCCM; and Daiwai Olson, RN, PhD , CCRN, FNCS It is an exciting time to be in neurocritical care. There has been tremendous growth of this field with important progress in education, patient quality and advocacy, and training in the last decade. The progress in research has been remarkable, with the recent publication of important clinical trials and observational studies. However, ...