Non-Occlusive Mesenteric Ischemia in Cardiac Arrest Patients

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Abstract

Non-occlusive mesenteric ischemia (NOMI) is a severe complication in patients after cardiac arrest (CA). The diagnosis is complicated, the treatment options are limited. Given the susceptibility of enterocytes to ischemia, the incidence and severity of NOMI in the post-resuscitation period may reflect the intensity and duration of both ischemia and subsequent reperfusion injury. NOMI is considered to be associated with adverse neurological outcomes in CA patients. Therefore, NOMI should not only be regarded as a post-resuscitation complication but also as one of the prognostic markers in CA patients.This paper summarizes current knowledge on NOMI’s pathophysiology, diagnosis, treatment, and prognostic significance in CA patients.

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Most cited references 76

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Successful cardiopulmonary resuscitation after cardiac arrest as a "sepsis-like" syndrome.

Christophe Adrie, Minou Adib-Conquy, Ivan Laurent … (2002)

We investigated the immunoinflammatory profile of patients successfully resuscitated after cardiac arrest, representing a model of whole-body ischemia/reperfusion syndrome. Plasma cytokine, endotoxin, and ex vivo cytokine production in whole-blood assays was assessed in 61, 35, and 11 patients, respectively. On admission, high levels of plasma interleukin (IL)-6, IL-8, IL-10, and soluble tumor necrosis factor (TNF) receptor type II could discriminate between survivors and nonsurvivors. Among nonsurvivors, the initial need for a vasopressor agent was associated with higher levels of IL-1 receptor antagonist, IL-10, and IL-6 on day 1. Plasma endotoxin was detected in 46% of the analyzed patients within the 2 first days. Endotoxin-induced TNF and IL-6 productions were dramatically impaired in these patients compared with healthy control subjects, whereas an unaltered production was observed with heat-killed Staphylococcus aureus. In contrast, IL-1 receptor antagonist productions were enhanced in these patients compared with healthy control subjects. The productions of T-cell-derived IL-10 and interferon-gamma were also impaired in these patients. Finally, using in vitro plasma exchange between healthy control subjects and patients, we demonstrated that the endotoxin-dependent hyporeactivity was an intrinsic property of patients' leukocytes and that an immunosuppressive activity was also present in their plasma. Altogether, the high levels of circulating cytokines, the presence of endotoxin in plasma, and the dysregulated production of cytokines found in these patients recall the immunological profile found in patients with sepsis.

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Acute mesenteric ischemia: guidelines of the World Society of Emergency Surgery

Miklosh Bala, Jeffry L Kashuk, Ernest E Moore … (2017)

Acute mesenteric ischemia (AMI) is typically defined as a group of diseases characterized by an interruption of the blood supply to varying portions of the small intestine, leading to ischemia and secondary inflammatory changes. If untreated, this process will eventuate in life threatening intestinal necrosis. The incidence is low, estimated at 0.09–0.2% of all acute surgical admissions. Therefore, although the entity is an uncommon cause of abdominal pain, diligence is always required because if untreated, mortality has consistently been reported in the range of 50%. Early diagnosis and timely surgical intervention are the cornerstones of modern treatment and are essential to reduce the high mortality associated with this entity. The advent of endovascular approaches in parallel with modern imaging techniques may provide new options. Thus, we believe that a current position paper from World Society of Emergency Surgery (WSES) is warranted, in order to put forth the most recent and practical recommendations for diagnosis and treatment of AMI. This review will address the concepts of AMI with the aim of focusing on specific areas where early diagnosis and management hold the strongest potential for improving outcomes in this disease process. Some of the key points include the prompt use of CT angiography to establish the diagnosis, evaluation of the potential for revascularization to re-establish blood flow to ischemic bowel, resection of necrotic intestine, and use of damage control techniques when appropriate to allow for re-assessment of bowel viability prior to definitive anastomosis and abdominal closure.

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Effect of Intra-arrest Transport, Extracorporeal Cardiopulmonary Resuscitation, and Immediate Invasive Assessment and Treatment on Functional Neurologic Outcome in Refractory Out-of-Hospital Cardiac Arrest: A Randomized Clinical Trial

Jan Belohlavek, Jana Smalcova, Daniel Rob … (2022)

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Author and article information

Contributors

Jana Smalcova

Chien-Hua Huang: Role: Academic Editor

Journal

Journal ID (nlm-ta): Rev Cardiovasc Med

Journal ID (publisher-id): RCM

Title: Reviews in Cardiovascular Medicine

Publisher: IMR Press

ISSN (Print): 2153-8174

ISSN (Electronic): 1530-6550

Publication date (Electronic): 19 September 2023

Publication date Collection: September 2023

Volume: 24

Issue: 9

Electronic Location Identifier: 262

Affiliations

[1] ¹Anaesthesiology and Resuscitation Department, Cardiac Centre, Institute for Clinical and Experimental Medicine, 14000 Prague, Czech Republic

[2] ²First Faculty of Medicine, Charles University, 12108 Prague, Czech Republic

[3] ³2nd Department of Medicine – Department of Cardiovascular Medicine, General University Hospital, 12800 Prague, Czech Republic

Author notes

^*Correspondence: jana.smalcova@ 123456gmail.com (Jana Smalcova)

Article

Publisher ID: S1530-6550(23)01025-6

DOI: 10.31083/j.rcm2409262

PMC ID: 11270105

PubMed ID: 39076401

SO-VID: c75a8264-e66c-42f1-9047-350941985727

License:

This is an open access article under the CC BY 4.0 license.

History

Date received : 1 April 2023

Date revision received : 8 May 2023

Date accepted : 18 May 2023

Funding

Funded by: “Cooperatio – Intensive Care Medicine”

Funded by: Ministry of Health, Czech Republic

Award ID: MH CZ-DRO-VFN64165

Supported by program “Cooperatio – Intensive Care Medicine” and by a research grant from the Ministry of Health, Czech Republic – conceptual development of research organisation, General University Hospital in Prague, MH CZ-DRO-VFN64165.

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Non-Occlusive Mesenteric Ischemia in Cardiac Arrest Patients

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Most cited references 76

Successful cardiopulmonary resuscitation after cardiac arrest as a "sepsis-like" syndrome.

Acute mesenteric ischemia: guidelines of the World Society of Emergency Surgery

Effect of Intra-arrest Transport, Extracorporeal Cardiopulmonary Resuscitation, and Immediate Invasive Assessment and Treatment on Functional Neurologic Outcome in Refractory Out-of-Hospital Cardiac Arrest: A Randomized Clinical Trial

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