A systematic review of neuroprotective strategies after cardiac arrest: from bench to bedside (part II-comprehensive protection).

Abstract

Neurocognitive impairment is a major source of morbidity among cardiac arrest survivors. This systematic review examined neuroprotective strategies targeting multiple stages of the neuropathological cascade following global cerebral ischemia. Pharmaceutical candidates reviewed included adenosine, brain-derived neurotrophic factor (BDNF), insulin-like growth factor-1 (IGF-1), glycine-proline-glutamate, granulocyte colony-stimulating factor (G-CSF), and estrogen; preclinical data for these agents were suggestive but inconclusive. Among medical gases evaluated in experimental models—hydrogen sulfide, hyperbaric oxygen, and molecular hydrogen—hyperbaric oxygen and molecular hydrogen demonstrated encouraging outcomes. The authors conclude that multi-target neuroprotective approaches hold promise for improving neurological recovery and survival, though clinical translation requires additional investigation.

Mechanism

Molecular hydrogen and hyperbaric oxygen are proposed to confer neuroprotection by modulating multiple steps within the neuropathological cascade triggered by global cerebral ischemia following cardiac arrest, though precise mechanistic details remain under investigation.