Literature Watch

Stroke   (04/29/20) doi: 10.1161/STROKEAHA.120.03010 Nguyen, Thanh N.; Abdalkader, Mohamad; Jovin, Tudor G.; et al. https://www.ahajournals.org/doi/pdf/10.1161/STROKEAHA.120.030100   The Society of Vascular and Interventional Neurology (SVIN) has released a guidance statement on acute ischemic large vessel occlusion strokes in an effort to reduce the transmission of COVID-19 and optimize healthcare resources. The document divides treatment for acute stroke into four phases: prehospital to the emergency department, prethrombectomy, thrombectomy ...

Olsen HT et al. Nonsedation or light sedation in critically ill, mechanically ventilated patients. NEJM. DOI: 10.1056/NEJMoa1906759 Reviewed by Sanjeev Sivakumar, MD Read the article .*   Background/Methods Sedating patients who require mechanical ventilation has been considered standard of care; however, clinical trials have suggested worse outcomes with use of sedatives.  This was a multi-center randomized clinical trial to investigate whether no sedation, compared with light sedation with daily interruption, would result in better ...

Circulation (04/09/20) doi: 10.1161/CIRCULATIONAHA.120.047463 Edelson, Dana P.; Sasson, Comilla; Chan, Paul S.; et al. https://www.ahajournals.org/doi/pdf/10.1161/CIRCULATIONAHA.120.047463 The American Heart Association (AHA) and seven other medical organizations have issued interim guidance regarding cardiopulmonary resuscitation (CPR) for victims of cardiac arrest with suspected or confirmed COVID-19 infection.  “The challenge is to ensure that patients with or without COVID-19 who experience cardiac arrest get the best possible chance of ...

International Journal of Stroke (04/07/20) doi: 10.1177/1747493020912602 Halstead, Michael R.; Mould, W. Andrew; Sheth, Kevin N.; et al. https://journals.sagepub.com/doi/abs/10.1177/1747493020912602 New research highlights the role of haptoglobin (Hp) phenotype in understanding the progression of perihematomal volume in spontaneous intracerebral hemorrhage. The study sought to determine whether rates of early perihematomal edema formation in people with Hp 1-1 phenotype differ from those with Hp 2-1 and Hp 2-2. Among 166 participants, taken ...

Johnson NJ, Danielson KR, Counts CR, et al. Targeted temperature management at 33 versus 36 degrees: A retrospective cohort study. Crit Care Med . 2020 Mar;48(3):362-369. 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.     Background/Methods Targeted temperature management (TTM) has become standard of care in post-cardiac arrest survivors after two landmark studies in 2002 demonstrated improved neurological outcomes ...

Sawyer KN, Humbert A, Leroux BG, et al. Relationship between duration of targeted temperature management, ischemic interval, and good functional outcome from out-of-hospital cardiac arrest. Crit Care Med 2020; 48(3):370-377. 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.     Summary Targeted temperature management (TTM), or induced hypothermia, likely offers neuroprotection in patients after cardiac arrest. However, ...

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 ...