Acute Lung Injury and Post-cardiac Arrest Syndrome: a Narrative Review

Overview

Journal J Intensive Care

Publisher Biomed Central

Specialty Critical Care

Date 2024 Sep 3

PMID 39227997

Authors

Yusuke Endo

Tomoaki Aoki

Daniel Jafari

Daniel M Rolston

Jun Hagiwara

Kanako Ito-Hagiwara

Eriko Nakamura

Cyrus E Kuschner

Lance B Becker

Kei Hayashida

Affiliations

Soon will be listed here.

Abstract

Background: Post-cardiac arrest syndrome (PCAS) presents a multifaceted challenge in clinical practice, characterized by severe neurological injury and high mortality rates despite advancements in management strategies. One of the important critical aspects of PCAS is post-arrest lung injury (PALI), which significantly contributes to poor outcomes. PALI arises from a complex interplay of pathophysiological mechanisms, including trauma from chest compressions, pulmonary ischemia-reperfusion (IR) injury, aspiration, and systemic inflammation. Despite its clinical significance, the pathophysiology of PALI remains incompletely understood, necessitating further investigation to optimize therapeutic approaches.

Methods: This review comprehensively examines the existing literature to elucidate the epidemiology, pathophysiology, and therapeutic strategies for PALI. A comprehensive literature search was conducted to identify preclinical and clinical studies investigating PALI. Data from these studies were synthesized to provide a comprehensive overview of PALI and its management.

Results: Epidemiological studies have highlighted the substantial prevalence of PALI in post-cardiac arrest patients, with up to 50% of survivors experiencing acute lung injury. Diagnostic imaging modalities, including chest X-rays, computed tomography, and lung ultrasound, play a crucial role in identifying PALI and assessing its severity. Pathophysiologically, PALI encompasses a spectrum of factors, including chest compression-related trauma, pulmonary IR injury, aspiration, and systemic inflammation, which collectively contribute to lung dysfunction and poor outcomes. Therapeutically, lung-protective ventilation strategies, such as low tidal volume ventilation and optimization of positive end-expiratory pressure, have emerged as cornerstone approaches in the management of PALI. Additionally, therapeutic hypothermia and emerging therapies targeting mitochondrial dysfunction hold promise in mitigating PALI-related morbidity and mortality.

Conclusion: PALI represents a significant clinical challenge in post-cardiac arrest care, necessitating prompt diagnosis and targeted interventions to improve outcomes. Mitochondrial-related therapies are among the novel therapeutic strategies for PALI. Further clinical research is warranted to optimize PALI management and enhance post-cardiac arrest care paradigms.

References

Angus S, Henderson W, Banoei M, Molgat-Seon Y, Peters C, Parmar H . Therapeutic hypothermia attenuates physiologic, histologic, and metabolomic markers of injury in a porcine model of acute respiratory distress syndrome. Physiol Rep. 2022; 10(9):e15286. PMC: 9069168. DOI: 10.14814/phy2.15286. View

Czerwinska-Jelonkiewicz K, Grand J, Tavazzi G, Sans-Rosello J, Wood A, Oleksiak A . Acute respiratory failure and inflammatory response after out-of-hospital cardiac arrest: results of the Post-Cardiac Arrest Syndrome (PCAS) pilot study. Eur Heart J Acute Cardiovasc Care. 2020; 9(4_suppl):S110-S121. DOI: 10.1177/2048872619895126. View

Johnson N, Caldwell E, Carlbom D, Gaieski D, Prekker M, Rea T . The acute respiratory distress syndrome after out-of-hospital cardiac arrest: Incidence, risk factors, and outcomes. Resuscitation. 2019; 135:37-44. DOI: 10.1016/j.resuscitation.2019.01.009. View

Faust H, Reilly J, Anderson B, Ittner C, Forker C, Zhang P . Plasma Mitochondrial DNA Levels Are Associated With ARDS in Trauma and Sepsis Patients. Chest. 2019; 157(1):67-76. PMC: 6965693. DOI: 10.1016/j.chest.2019.09.028. View

Sutherasan Y, Penuelas O, Muriel A, Vargas M, Frutos-Vivar F, Brunetti I . Management and outcome of mechanically ventilated patients after cardiac arrest. Crit Care. 2015; 19:215. PMC: 4457998. DOI: 10.1186/s13054-015-0922-9. View

Mai N, Miller-Rhodes K, Knowlden S, Halterman M . The post-cardiac arrest syndrome: A case for lung-brain coupling and opportunities for neuroprotection. J Cereb Blood Flow Metab. 2019; 39(6):939-958. PMC: 6547189. DOI: 10.1177/0271678X19835552. View

Neumar R, Nolan J, Adrie C, Aibiki M, Berg R, Bottiger B . Post-cardiac arrest syndrome: epidemiology, pathophysiology, treatment, and prognostication. A consensus statement from the International Liaison Committee on Resuscitation (American Heart Association, Australian and New Zealand Council on.... Circulation. 2008; 118(23):2452-83. DOI: 10.1161/CIRCULATIONAHA.108.190652. View

Radu R, Kaserer A, Seifert B, Simmen H, Ruetzler K, Spahn D . Prevalence and in-hospital outcome of aspiration in out-of-hospital intubated trauma patients. Eur J Emerg Med. 2017; 25(5):362-367. DOI: 10.1097/MEJ.0000000000000465. View

Venereau E, Ceriotti C, Bianchi M . DAMPs from Cell Death to New Life. Front Immunol. 2015; 6:422. PMC: 4539554. DOI: 10.3389/fimmu.2015.00422. View

10.

Pagano A, Barazzone-Argiroffo C . Alveolar cell death in hyperoxia-induced lung injury. Ann N Y Acad Sci. 2004; 1010:405-16. DOI: 10.1196/annals.1299.074. View

11.

Robba C, Poole D, McNett M, Asehnoune K, Bosel J, Bruder N . Mechanical ventilation in patients with acute brain injury: recommendations of the European Society of Intensive Care Medicine consensus. Intensive Care Med. 2020; 46(12):2397-2410. PMC: 7655906. DOI: 10.1007/s00134-020-06283-0. View

12.

Zhou T, Wang X, Wang K, Lin Y, Meng Z, Lan Q . Activation of aldehyde dehydrogenase-2 improves ischemic random skin flap survival in rats. Front Immunol. 2023; 14:1127610. PMC: 10335790. DOI: 10.3389/fimmu.2023.1127610. View

13.

Nolan J, Sandroni C, Bottiger B, Cariou A, Cronberg T, Friberg H . European Resuscitation Council and European Society of Intensive Care Medicine guidelines 2021: post-resuscitation care. Intensive Care Med. 2021; 47(4):369-421. PMC: 7993077. DOI: 10.1007/s00134-021-06368-4. View

14.

Hua T, Yang M, Zhou Y, Chen L, Wu H, Liu R . Alda-1 Prevents Pulmonary Epithelial Barrier Dysfunction following Severe Hemorrhagic Shock through Clearance of Reactive Aldehydes. Biomed Res Int. 2019; 2019:2476252. PMC: 6699483. DOI: 10.1155/2019/2476252. View

15.

Aoki T, Endo Y, Nakamura E, Kuschner C, Kazmi J, Singh P . Therapeutic potential of mitochondrial transplantation in modulating immune responses post-cardiac arrest: a narrative review. J Transl Med. 2024; 22(1):230. PMC: 10909283. DOI: 10.1186/s12967-024-05003-2. View

16.

Eastwood G, Nichol A, Hodgson C, Parke R, McGuinness S, Nielsen N . Mild Hypercapnia or Normocapnia after Out-of-Hospital Cardiac Arrest. N Engl J Med. 2023; 389(1):45-57. DOI: 10.1056/NEJMoa2214552. View

17.

Tiruvoipati R, Pilcher D, Botha J, Buscher H, Simister R, Bailey M . Association of Hypercapnia and Hypercapnic Acidosis With Clinical Outcomes in Mechanically Ventilated Patients With Cerebral Injury. JAMA Neurol. 2018; 75(7):818-826. PMC: 5885161. DOI: 10.1001/jamaneurol.2018.0123. View

18.

Stub D, Bernard S, Duffy S, Kaye D . Post cardiac arrest syndrome: a review of therapeutic strategies. Circulation. 2011; 123(13):1428-35. DOI: 10.1161/CIRCULATIONAHA.110.988725. View

19.

Wicky S, Wintermark M, Schnyder P, Capasso P, Denys A . Imaging of blunt chest trauma. Eur Radiol. 2000; 10(10):1524-38. DOI: 10.1007/s003300000435. View

20.

Wei J, Wang P, Li Y, Dou Q, Lin J, Tao W . Inhibition of RHO Kinase by Fasudil Attenuates Ischemic Lung Injury After Cardiac Arrest in Rats. Shock. 2017; 50(6):706-713. DOI: 10.1097/SHK.0000000000001097. View