Literature Watch

New England Journal of Medicine (10/20/22) DOI: 10.1056/NEJMoa2208687 Kjaergaard, Jesper; Møller, Jacob E.; Schmidt, Henrik; et al. https://www.nejm.org/doi/full/10.1056/NEJMoa2208687 For patients who had been resuscitated from cardiac arrest, targeting a mean arterial blood pressure of 77 mm Hg or 63 mm Hg did not result in significant differences in terms of the percentages of patients who died or had severe disability or coma, new research indicates. The double-blind trial randomly assigned 393 comatose adults who had been resuscitated after ...

New England Journal of Medicine (10/20/22) DOI: 10.1056/NEJMoa2208686 Schmidt, Henrik; Kjaergaard, Jesper; Hassager, Christian; et al. https://www.nejm.org/doi/full/10.1056/NEJMoa2208686 Following a restrictive or liberal oxygenation strategy for comatose patients after resuscitation for cardiac arrest led to a similar incidence of death or severe disability or coma, according to new research. Comatose patients with out-of-hospital cardiac arrest were randomly assigned to either a restrictive oxygen target of a partial pressure of arterial oxygen ...

By Matthew Bower, MD Neurology Resident (PGY-4), UC Irvine Incoming Neurocritical Care Fellow 2022 Johns Hopkins University By Sara Stern-Nezer, MD, MPH Assistant Clinical Professor Departments of Neurology & Neurosurgery University of California, Irvine Original Article: Ruijter B, Keijzer M, et al. Treating Rhythmic and Periodic EEG Patterns in Comatose Survivors of Cardiac Arrest. NEJM (2022). DOI: 10.1056/NEJMoa2115998 Summary Spontaneous intracerebral hemorrhage (ICH) accounts for 15% of all strokes and a significant burden ...

New England Journal of Medicine (11/06/22) DOI: 10.1056/NEJMoa2212528 Hassager, Christian; Schmidt, Henrik; Møller, Jacob E.; et al. https://www.nejm.org/doi/full/10.1056/NEJMoa2212528 New research out of Denmark evaluated two methods of device-based fever prevention in comatose adult patients who had been resuscitated after an out-of-hospital cardiac arrest. For the study, 393 patients were randomized to device-based temperature control targeting 36°C for 24 hours, followed by targeting of 37°C for 12 hours (36 hours total), or until the ...

The Lancet Neurology (08/01/22) Vol. 21, No. 8, P. 714, DOI: 10.1016/S1474-4422(22)00208-3 Charidimou, Andreas; Boulouis, Gregoire; Frosch, Matthew P.; et al. https://www.thelancet.com/journals/laneur/article/PIIS1474-4422(22)00208-3/fulltext An international collaborative study sought to update the Boston diagnostic criteria for the full range of cerebral amyloid angiopathy (CAA) presentations. The criteria had not been updated since 2010. The authors conducted a retrospective analysis of clinical, radiological, and histopathological data available ...

The Lancet Neurology (08/01/22) Vol. 21, No. 8, P. 704, DOI: 10.1016/S1474-4422(22)00212-5 Egbebike, Jennifer; Shen, Qi; Doyle, Kevin; et al. https://www.thelancet.com/journals/laneur/article/PIIS1474-4422(22)00212-5/fulltext For clinically unresponsive patients with acute brain injury, new research shows that cognitive-motor dissociation is an independent predictor of shorter time to good recovery. Other such factors include underlying traumatic brain injury or subdural hematoma, a Glasgow Coma Scale score on admission of at least 8, and younger ...

New England Journal of Medicine (10/13/22) DOI: 10.1056/NEJMoa2206317 Tao, Chunrong; Nogueira, Raul G.; Zhu, Yuyou; et al. https://www.nejm.org/doi/full/10.1056/NEJMoa2206317 New research shows that for patients who experienced a basilar arterial occlusion, an endovascular thrombectomy in 12 hours was linked to improved functional outcomes at 90 days compared with best medical care. The prospective ATTENTION trial, conducted at 36 centers in China, randomized patients who were within 12 hours of the estimated time of basilar-artery occlusion ...

Intensive Care Medicine (10/20/22) DOI: 10.1007/s00134-022-06884-x Rezoagli, Emanuele; Petrosino, Matteo; Rebora, Paola; et al. https://link.springer.com/article/10.1007/s00134-022-06884-x Two large, prospective multicenter cohort studies examined if exposure to high blood oxygen levels and high oxygen supplementation were independently associated with outcomes in traumatic brain injury (TBI) patients admitted to the intensive care unit and receiving mechanical ventilation. The studies, conducted in Europe (CENTER-TBI cohort) and Australia ...

JAMA Neurology (6/06/22) DOI: 10.1001/jamaneurol.2022.1070 Kolias, AG; Adams, H; Timofeev, IS; et al. https://jamanetwork.com/journals/jamaneurology/article-abstract/2792806 At 2 years, patients with traumatic intracranial hypertension who underwent a decompressive craniectomy were more likely to improve over time, compared with patients who received standard medical care, according to new research. The prespecified secondary analysis of the Randomized Evaluation of Surgery With Craniectomy for Uncontrollable Elevation of Intracranial Pressure ...

Jiping Zhou, MD, MPH PGY-3 resident in Neurology Wayne State University/Detroit Medical Center Wazim Mohamed, MD Associate Professor of Neurology and Neurosurgery Wayne State University R oberg, Lars Egil, et al. "Prediction of Long-term Survival After Status Epilepticus Using the ACD Score." JAMA neurology (2022). Background/Methods Status epilepticus (SE) is a neurological emergency with a high in-hospital and long-term mortality. However, evidence regarding risk factors associated with post-SE neurological outcomes and mortality ...

The Lancet (07/16/22) Vol. 400, No. 10347, P. 161, DOI: 10.1016/S0140-6736(22)01054-6 Menon, BK; Buck, BH; Singh, N; et al. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(22)01054-6/fulltext Research conducted in Canada explored tenecteplase as an alternative to alteplase in intravenous thrombolysis for the treatment of acute ischemic stroke. Approximately one-half of the study's 1,600 adult participants were randomly assigned to standard care, defined as a bolus of 0.9 mg/kg alteplase followed by an hour-long infusion of up to ...

Stroke (05/17/22) DOI: 10.1161/STR.0000000000000407 Greenberg, Steven M.; Ziai, Wendy C.; Cordonnier, Charlotte; et al. https://www.ahajournals.org/doi/10.1161/STR.0000000000000407 The American Heart Association (AHA) and American Stroke Association (ASA) have released updated guidelines for the management of individuals with spontaneous intracerebral hemorrhage (ICH). The guidelines for the management of spontaneous ICH were last updated in 2015. The updated guidance is limited to spontaneous ICHs that are not caused by head trauma and do not have ...

Clinical Neurophysiology (05/06/22) DOI: 10.1016/j.clinph.2022.04.018 Amorim, Edilberto; Firme, Marcos S.; Zheng, Wei-Long; et al. https://www.sciencedirect.com/science/article/abs/pii/S1388245722002619 A recent study sought to estimate the prevalence of seizures and ictal-interictal continuum patterns in patients undergoing electroencephalography (EEG) during extracorporeal membrane oxygenation (ECMO). The retrospective review of a prospective ECMO registry from 2011-2018 included adult patients who had reduced level of consciousness and underwent ...

Arshdeep Kaur, MD PGY-3 resident in Neurology Wayne State University/Detroit Medical Center Wazim Mohamed, MD Associate Professor of Neurology and Neurosurgery Wayne State University Khan, Abid D., et al. "A multicenter validation of the Modified Brain Injury Guidelines (mBIG): are they safe and effective?." The Journal of Trauma and Acute Care Surgery (2022). Background/Methods: Traumatic brain injury accounts for a substantial number of ER visits and hospital admissions requiring extensive resource utilization. This patient ...

Journal of the American Medical Association (05/04/22) DOI: 10.1001/jama.2022.4798 Bösel, Julian; Niesen, Wolf-Dirk; Salih, Farid; et al. https://jamanetwork.com/journals/jama/fullarticle/2792016 Early tracheostomy does not significantly increase survival without severe disability at 6 months for patients with severe stroke receiving mechanical ventilation, researchers report. The SETPOINT2 study, which was conducted at U.S. and German neurocritical care units between 2015 and 2020, included 382 patients with severe acute ischemic or hemorrhagic ...

Intensive Care Medicine (06/01/22) DOI: 10.1007/s00134-022-06712-2 Lewis, Kimberley; Alshamsi, Fayez; Carayannopoulos, Kallirroi Laiya; et al. https://link.springer.com/article/10.1007/s00134-022-06712-2 A recent study highlights the benefits of dexmedetomidine for mechanically ventilated adults. According to the data, use of dexmedetomidine compared with other sedatives led to a lower risk of delirium and a modest reduction of mechanical ventilation and ICU stay, although the risk for bradycardia and hypotension increased. The systematic review ...

Matthew Bower, MD Neurology Resident (PGY-4), UC Irvine Incoming Neurocritical Care Fellow 2022 Johns Hopkins University Sara Stern-Nezer, MD, MPH Assistant Clinical Professor Departments of Neurology & Neurosurgery University of California, Irvine Ruijter B, Keijzer M, et al. Treating Rhythmic and Periodic EEG Patterns in Comatose Survivors of Cardiac Arrest. NEJM (2022). DOI: 10.1056/NEJMoa2115998 Background: Up to 10-35% of comatose post cardiac arrest patients have epileptiform activity such as periodic generalized discharges (GPDs) or ...

Gantner D, Wiegers E, Bragge P, Finfer S, Delaney A, van Essen T, Peul W, Maas AIR, Cooper DJ. Decompressive Craniectomy Practice following Traumatic Brain Injury in Comparison with Randomized Trials: Harmonized, Multi-Center Cohort Studies in Europe, the United Kingdom, and Australia. J Neurotrauma. 2022 Apr 6. doi: 10.1089/neu.2021.0312. Epub ahead of print. PMID: 35243877. Background : Severe traumatic brain injury (TBI) is highly disabling, with over 50% of patients facing mortality or long-term disability. Secondary decompressive craniectomy ...

Herniation World Federation of Neurosurgical Societies Scale Improves Prediction of Outcome in Patients with Poor-Grade Aneurysmal Subarachnoid Hemorrhage Stroke (03/22/22) DOI: 10.1161/STROKEAHA.121.036699 Raabe, Andreas; Beck, Jürgen; Goldberg, Johannes; et al. https://www.ahajournals.org/doi/10.1161/STROKEAHA.121.036699 An international prospective multicenter study involving poor-grade aneurysmal subarachnoid hemorrhage patients compared the World Federation of Neurosurgical Societies (WFNS) classification with a modified version, the herniation ...

Effects of Clazosentan on Cerebral Vasospasm–Related Morbidity and All-Cause Mortality after Aneurysmal Subarachnoid Hemorrhage: Two Randomized Phase 3 Trials in Japanese Patients Journal of Neurosurgery (04/01/22) DOI: 10.3171/2022.2.JNS212914 Endo, Hidenori; Hagihara, Yasushi; Kimura, Naoto; et al. https://thejns.org/view/journals/j-neurosurg/aop/article-10.3171-2022.2.JNS212914/article-10.3171-2022.2.JNS212914.xml New research out of Japan indicates that clazosentan led to significant reductions in the incidence of vasospasm-related morbidity ...

Perera KS, et al. Young ESUS Investigators. Evaluating Rates of Recurrent Ischemic Stroke Among Young Adults With Embolic Stroke of Undetermined Source: The Young ESUS Longitudinal Cohort Study. JAMA Neurol. 2022 Mar 14. PMID: 35285869 Background: Embolic stroke of undetermined source (ESUS) is defined as ischemic stroke(s) that is non-lacunar in nature and without any identified major cardioembolic etiology. In younger adults (<50 years of age), ESUS can comprise up to 40 percent of ischemic stroke cases. Silent atrial fibrillation (AF) has been ...

Endovascular Therapy for Acute Stroke with a Large Ischemic Region New England Journal of Medicine (04/07/22) DOI: 10.1056/NEJMoa2118191 Yoshimura, Shinichi; Sakai, Nobuyuki; Hiroshi Yamagami; et al. https://www.nejm.org/doi/full/10.1056/NEJMoa2118191 Researchers conducted a randomized clinical trial in Japan involving patients with occlusion of large cerebral vessels and sizable strokes on imaging, as indicated by an Alberta Stroke Program Early Computed Tomographic Score (ASPECTS) value of 3 to 5. The multicenter, open-label study randomized ...

New England Journal of Medicine (02/24/22); 386(8):724-734. DOI: 10.1056/NEJMoa2115998 Ruijter, Barry J.; Keijzer, Hanneke M.; Tjepkema-Cloostermans, Marleen C.; et al. https://www.nejm.org/doi/full/10.1056/NEJMoa2115998 The Treatment of Electroencephalographic Status Epilepticus after Cardiopulmonary Resuscitation (TELSTAR) trial sought to determine whether the use of intensive, stepwise antiseizure and sedative therapy to suppress rhythmic and periodic EEG patterns detected in continuous EEG monitoring would affect the outcomes for comatose ...

Background: Non-traumatic subarachnoid hemorrhage (SAH) is a devastating disease that accounts for less than 10% of all strokes but is one of the most common cause of stroke-related deaths. However, for a small subset of these patients, specifically those in which a bleed source cannot be identified (angiogram-negative), outcomes tend to be more favorable. This group can be further subdivided into patients with a perimesencephalic bleed (PMH) and non-perimesencephalic (nPMH) bleeding patterns, with some studies suggesting differences in outcomes between ...

Journal of the American Medical Association (02/22/22); 327(8):737-747. DOI: 10.1001/jama.2022.1025 Belohlavek, Jan; Smalcova, Jana; Rob, Daniel; et al. https://jamanetwork.com/journals/jama/fullarticle/2789313 The combination of early intra-arrest transport, extracorporeal cardiopulmonary resuscitation, and invasive assessment and treatment did not significantly increase survival with neurologically favorable outcome at 180 days for patients with refractory out-of-hospital cardiac arrest (OHCA), compared with standard resuscitation, according ...

Direct Oral Anticoagulants Versus Warfarin in the Treatment of Cerebral Venous Thrombosis (ACTION-CVT): A Multicenter International Study Stroke (02/10/22) DOI: 10.1161/STROKEAHA.121.037541 Yaghi, Shadi; Shu, Liqi; Bakradze, Ekaterina; et al. https://www.ahajournals.org/doi/10.1161/STROKEAHA.121.037541 An international retrospective study compared direct oral anticoagulants (DOACs) with warfarin in a real-world cerebral venous thrombosis (CVT) cohort. The study included 845 patients with CVT who received oral anticoagulants from January 2015 ...

Statins and the risk of Intracranial hemorrhage. Is there a link? Amarenco P, et al; Treat Stroke to Target Investigators. Intracranial Hemorrhage in the TST Trial. Stroke. 2022 Feb;53(2):457-462. DOI: 10.1161/STROKEAHA.121.035846 Background/Methods Statins are recommended after a transient ischemic attack (TIA) or an ischemic stroke of atherosclerotic origin according to the AHA/ASA guidelines. The SPARCL trial (Stroke Prevention by Aggressive Reduction in Cholesterol Level) found patients with an ischemic event on statins had lower risk of ...

Endovascular Therapy for Acute Stroke with a Large Ischemic Region New England Journal of Medicine (02/09/22) DOI: 10.1056/NEJMoa2118191 Yoshimura, Shinichi; Sakai, Nobuyuki; Yamagami, Hiroshi; et.al. https://www.nejm.org/doi/full/10.1056/NEJMoa2118191 Researchers in Japan explored the effect of endovascular therapy for acute ischemic stroke with large infarctions. In a sample population of 203 participants, they randomized one-half to receive usual medical care only and the other one-half to receive usual medical care plus endovascular therapy. ...

Cereda CW, Bianco G et al. Perfusion Imaging Predicts Favorable Outcomes after Basilar Artery Thrombectomy. ANN NEUROL 2022;91:23–32 Summary Background/Methods Randomized trials support the use of perfusion imaging to identify patients with anterior circulation large vessel occlusive disease that are likely to benefit from thrombectomy. There is paucity of data on the use of perfusion imaging as well as demonstrating a benefit of thrombectomy in basilar artery occlusion (BAO). The authors of the current study sought to investigate the utility ...

van Veen E, van der Jagt M, Citerio G, et al. Occurrence and timing of withdrawal of life-sustining measures in traumatic brain injury patients: a CENTER-TBI study. Intensive Care Med . 2021;47(10):1115-1129. doi:10.1007/s00134-021-06484-1 Read the Full Article Background: In patients with devastating brain injury, the Neurocritical Care Society recommends 72 hours of observation prior to formal decisions on the withdrawal of life sustaining measures (WSLM). Prognostication in patients with severe traumatic brain injury is challenging, and ...

Monitoring Spinal Cord Tissue Oxygen in Patients With Acute, Severe Traumatic Spinal Cord Injuries Critical Care Medicine (01/06/22) DOI: 10.1097/CCM.0000000000005433 Visagan, Ravindran; Hogg, Florence R.A.; Gallagher, Mathew J.; et al. https://journals.lww.com/ccmjournal/Abstract/9000/Monitoring_Spinal_Cord_Tissue_Oxygen_in_Patients.95024.aspx A recent study investigated whether monitoring tissue oxygen tension from the injury site (p sct O 2 ) in patients with acute, severe traumatic spinal cord injuries is feasible. The study involved 26 ...