Effect of Xingnaojing Injection on Neurological Outcomes in patients with Extracorporeal cardiopulmonary resuscitation: A single-center retrospective cohort study

Article Sidebar

12-Sept-5797.pdf
Published Sep 30, 2024
DOI: https://doi.org/10.18103/mra.v12i9.5797

Downloads

Download data is not yet available.

Submit your own article

Register as an author to reserve your spot in the next issue of the Medical Research Archives.

Author Registration

Join the Society

The European Society of Medicine is more than a professional association. We are a community. Our members work in countries across the globe, yet are united by a common goal: to promote health and health equity, around the world.

Join Europe’s leading medical society and discover the many advantages of membership, including free article publication.

Membership

Main Article Content

Xiaozu Liao
Department of Anesthesiology, Zhongshan City People’s Hospital, Zhongshan, China
Zhou Cheng
Department of Anesthesiology, Zhongshan City People’s Hospital, Zhongshan, China
Shi Zhong
Department of Anesthesiology, Zhongshan City People’s Hospital, Zhongshan, China
Binfei Li
Department of Anesthesiology, Zhongshan City People’s Hospital, Zhongshan, China

Abstract

Background: Patients undergoing extracorporeal cardiopulmonary resuscitation (ECPR) have poor neurological prognoses and low survival rates. Xingnaojing injection (XNJ) is widely used in the acute phase of ischemic stroke. This study aimed to investigate the effects of XNJ on neurological outcomes in patients receiving ECPR.


Methods: Medical data of all patients who underwent ECPR at Zhongshan People's Hospital from January 2023 to March 2024 were collected. In this retrospective cohort study, patients were divided into XNJ and non-XNJ groups according to whether or not they used XNJ. Baseline data of patients were collected, including serum neuron-specific enolase (NSE) S-100 protein, TNF-α and IL-6 at 1 h, 24 h, 48 h and 72 h after extracorporeal membrane oxygenation (ECMO). The optimal Glasgow Coma Scale (GCS)at 24 and 72 hours after ECMO and the outcomes of neurological function and prognosis at discharge were evaluated. Univariate and multivariate logistic regressions were used to analyze the risk factors affecting patient prognosis.


Results: A total of 44 patients were included in this study; 22 in each group. The patients were 47 (38.0, 57.5) years old, the CPR time before ECMO was 30 (22, 50) min, and the APACHE II score was 28 (20, 31) points. ECMO assisted 96 (72,144) hours, ICU 7.5 (5, 12) days, 14.5 (6.3, 24) days in the hospital, 50% survived discharge, and 40.9% of patients had favorable neurological outcome at discharge. The GCSscores at 24 and 72 hours after ECMO were (9(3, 13) vs 9(3, 15), p=0.68), (12.5 (3, 15) vs 10 (3, 15), p=0.13), respectively. There was no statistically significant difference in Cerebral Performance Category (CPC) scores at discharge, p=0.68. The rate of favorable neurological outcomes at discharge between the XNJ and non-XNJ groups was 40.9% vs 40.9%, p=0.62, and there was no significant difference between the two groups in terms of survival and discharge (45.6% vs 54.5%, p=0.76). Serum S100 and NSE proteins, which are markers of brain injury, increased within 24 hours and decreased 48 hours later in both groups. The expression of S100 protein in the XNJ group at 24, 48, and 72 hours was lower than that in the non-XNJ group (p<0.05). The expression of NSE protein in the XNJ group at 48 and 72 hours was lower than that in the non-XNJ group (p<0.05). Serum TNF-α and IL-6, markers of inflammation in both groups, showed a decreasing trend at 24 hours after ECMO. The expression of serum TNF-α at 24 and 48 hours was lower in the XNJ group (p<0.05). The expression of IL-6 at 48 and 72 hours was lower in the XNJ group (p<0.05). The lactate level before ECMO (1.353 [1.020-1.796], p=0.036) was an independent risk factor for the prognosis of ECMO-assisted patients. ROC curve of pre-ECMO lactate level (AUC=0.75 (0.61-0.91), p<0.01.


Conclusion: XNJ may alleviate brain injury and inhibit the inflammatory response in patients undergoing ECPR but may not improve the neurological function and survival of patients at discharge.

Keywords: ECPR, Extracorporeal cardiopulmonary resuscitation, Brain injury, CPC, Cerebral performance category, Neurological outcome

Article Details

How to Cite
LIAO, Xiaozu et al. Effect of Xingnaojing Injection on Neurological Outcomes in patients with Extracorporeal cardiopulmonary resuscitation: A single-center retrospective cohort study. Medical Research Archives, [S.l.], v. 12, n. 9, sep. 2024. ISSN 2375-1924. Available at: <https://esmed.org/MRA/mra/article/view/5797>. Date accessed: 04 oct. 2024. doi: https://doi.org/10.18103/mra.v12i9.5797.
ABNT APA BibTeX CBE EndNote - EndNote format (Macintosh & Windows) MLA ProCite - RIS format (Macintosh & Windows) RefWorks Reference Manager - RIS format (Windows only) Turabian
Issue
Vol 12 No 9 (2024): Vol 12 No 9 (2024): September ISSUE, Issue 9, VOl.12
Section
Research Articles

The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.

 

References

1. Lynge, T.H., et al., Nationwide burden of sudden cardiac death: A study of 54,028 deaths in Denmark. Heart Rhythm, 2021. 18(10): p. 1657-1665.
2. Hayashi, M., W. Shimizu and C.M. Albert, The spectrum of epidemiology underlying sudden cardiac death. Circ Res, 2015. 116(12): p. 1887-906.
3. Andersen, L.W., et al., In-Hospital Cardiac Arrest: A Review. JAMA, 2019. 321(12): p. 1200-1210.
4. Richardson, A.S., et al., ECMO Cardio-Pulmonary Resuscitation (ECPR), trends in survival from an international multicentre cohort study over 12-years. Resuscitation, 2017. 112: p. 34-40.
5. Low, C., et al., Extracorporeal cardiopulmonary resuscitation versus conventional cardiopulmonary resuscitation in adults with cardiac arrest: a comparative meta-analysis and trial sequential analysis. Lancet Respir Med, 2023. 11(10): p. 883-893.
6. Low, C., et al., Extracorporeal cardiopulmonary resuscitation versus conventional CPR in cardiac arrest: an updated meta-analysis and trial sequential analysis. Crit Care, 2024. 28(1): p. 57.
7. Sekhon, M.S., P.N. Ainslie and D.E. Griesdale, Clinical pathophysiology of hypoxic ischemic brain injury after cardiac arrest: a "two-hit" model. Crit Care, 2017. 21(1): p. 90.
8. Guo, Y., et al., Use of angong niuhuang in treating central nervous system diseases and related research. Evid Based Complement Alternat Med, 2014. 2014: p. 346918.
9. Wu, B., et al., Meta-analysis of traditional Chinese patent medicine for ischemic stroke. Stroke, 2007. 38(6): p. 1973-9.
10. Zhang, Y.M., et al., XingNaoJing injection ameliorates cerebral ischaemia/reperfusion injury via SIRT1-mediated inflammatory response inhibition. Pharm Biol, 2020. 58(1): p. 16-24.
11. Chang, W.T., et al., Optimal Arterial Blood Oxygen Tension in the Early Postresuscitation Phase of Extracorporeal Cardiopulmonary Resuscitation: A 15-Year Retrospective Observational Study. Crit Care Med, 2019. 47(11): p. 1549-1556.
12. Sekhon, M.S., P.N. Ainslie and D.E. Griesdale, Clinical pathophysiology of hypoxic ischemic brain injury after cardiac arrest: a two-hit model. Crit Care, 2017. 21(1): p. 90.
13. Ryu, J.A., et al., Neurologic Outcomes in Patients Who Undergo Extracorporeal Cardiopulmonary Resuscitation. Ann Thorac Surg, 2019. 108(3): p. 749-755.
14. Olander, C.H., et al., Extracorporeal Cardiopulmonary Resuscitation Guided by End-Tidal Carbon Dioxide-a Porcine Model. J Cardiovasc Transl Res, 2022. 15(2): p. 291-301.
15. Olander, C.H., et al., End-Tidal Carbon Dioxide Impacts Brain and Kidney Injury in Experimental Extracorporeal Cardiopulmonary Resuscitation (ECPR). Shock, 2021. 55(4): p. 563-569.
16. Holmberg, M.J., et al., Extracorporeal cardiopulmonary resuscitation for cardiac arrest: A systematic review. Resuscitation, 2018. 131: p. 91-100.
17. Song, H., et al., Novel serum biomarkers for predicting neurological outcomes in postcardiac arrest patients treated with targeted temperature management. Crit Care, 2023. 27(1): p. 113.
18. Shinozaki, K., et al., Serum S-100B is superior to neuron-specific enolase as an early prognostic biomarker for neurological outcome following cardiopulmonary resuscitation. Resuscitation, 2009. 80(8): p. 870-5.
19. Kim, H.B., J.H. Yang and Y.H. Lee, Are serial neuron-specific enolase levels associated with neurologic outcome of ECPR patients: A retrospective multicenter observational study. Am J Emerg Med, 2023. 69: p. 58-64.
20. Bianchi, R., et al., S100B binding to RAGE in microglia stimulates COX-2 expression. J Leukoc Biol, 2007. 81(1): p. 108-18.
21. Wu, B., et al., Meta-analysis of traditional Chinese patent medicine for ischemic stroke. Stroke, 2007. 38(6): p. 1973-9.
22. Zhang, Y.M., et al., XingNaoJing injection ameliorates cerebral ischaemia/reperfusion injury via SIRT1-mediated inflammatory response inhibition. Pharm Biol, 2020. 58(1): p. 16-24.
23. Dong, X., et al., Xingnaojing injection alleviates cerebral ischemia/reperfusion injury through regulating endoplasmic reticulum stress in Vivo and in Vitro. Heliyon, 2024. 10(3): p. e25267.
24. Wagner, S.T. and W.L. Lanier, Metabolism of glucose, glycogen, and high-energy phosphates during complete cerebral ischemia. A comparison of normoglycemic, chronically hyperglycemic diabetic, and acutely hyperglycemic nondiabetic rats. Anesthesiology, 1994. 81(6): p. 1516-26.
25. Khanduja, S., et al., Hypoxic-Ischemic Brain Injury in ECMO: Pathophysiology, Neuromonitoring, and Therapeutic Opportunities. Cells, 2023. 12(11).
26. Shou, B.L., et al., Arterial oxygen and carbon dioxide tension and acute brain injury in extracorporeal cardiopulmonary resuscitation patients: Analysis of the extracorporeal life support organization registry. J Heart Lung Transplant, 2023. 42(4): p. 503-511.
27. Dell'Anna, A.M., et al., Prognostic implications of blood lactate concentrations after cardiac arrest: a retrospective study. Ann Intensive Care, 2017. 7(1): p. 101.
28. Dusik, M., et al., Serum lactate in refractory out-of-hospital cardiac arrest: Post-hoc analysis of the Prague OHCA study. Resuscitation, 2023. 192: p. 109935.
29. Aksoy, T., et al., Lactate and Lactate Clearance Are Predictive Factors for Mortality in Patients with Extracorporeal Membrane Oxygenation. Braz J Cardiovasc Surg, 2024. 39(2): p. e20230091.
30. Shoji, K., et al., Low-flow time and outcomes in out-of-hospital cardiac arrest patients treated with extracorporeal cardiopulmonary resuscitation. Am J Emerg Med, 2024. 75: p. 37-41.