Cardiac arrest

Pathophysiology of hypoxic-ischemic brain injury
See Main Article: Pathophysiology of hypoxic-ischemic brain injury

Medications
In a 2020 meta-analysis of clinical trials, epinephrine at standard dosage of 1 mg per dose is associated with a higher probability of ROSC (RR 3.09, 95% CI 2.82-3.39), survival to admission (RR 2.50, 95% CI 1.68-3.72), and survival to discharge (RR 1.44, 95% CI 1.11-1.86). However, it is not associated with favorable neurological status at discharge (RR 1.21, 95% CI 0.90-1.62). There may be a slight increase in rates of ROSC and survival to admission with high-dose epinephrine (>1 mg per dose) but no difference in survival to discharge.

Neurological
Some degree of brain hypoxia post-cardiac arrest is due to impaired oxygen diffusion, and is not modulated by changes in CPP.

ECMO
In ECMO after cardiac arrest, a PaO2 of 77-220 mmHg was the optimal range for good neurological outcome, meaning going back to independence.

In an autopsy study of patients on ECMO (mostly VA ECMO) who died, 44% had hypoxic-ischemic brain injury, 20% had subarachnoid hemorrhage, 16% had ischemic stroke, 8% had intraparenchymal hemorrhage, and 4% had subdural hemorrhage. Only 32% had no evidence of acute brain injury.

During ECMO in a pig model after cardiac arrest, infusion of carbon monoxide was associated with reduced brain injury.

Antibiotherapy during Therapeutic Hypothermia to Prevent Infectious Complications (ANTHARTIC, 2019).
This trial enrolled adult patients after out-of-hospital shockable-rhythm cardiac arrest who were treated with TTM to 32-34°C to 2-days of amoxicillin-clavulanate at a dose of 1g-200mg three times per day vs. placebo. Early ventilator-associated pneumonia was less common in the antibiotic group (HR 0.55, 95% CI 0.33-0.91). However there was no difference in mortality, the number of ventilator-free days, or neurological outcome as measured by Cerebral Performance Category.