Research Targets Long-Term Brain Deficits In Cardiac Arrest Survivors

Leslie Capo, Director of Information Services, LSUHSC 

Jason Middleton, Ph.D., Assistant Professor of Cell Biology and Anatomy, and Neuroscience at LSU Health New Orleans School of Medicine, and colleagues have performed research that may lead to a treatment to prevent long-term sensory problems by restoring normal brain function in survivors of cardiac arrest. The study, done in a rodent model and using modeling data, is published online in eNeuro, an open-access journal of the Society for Neuroscience.

Cardiac arrest is a common cause of brain injury. When the brain is deprived of oxygen, not only can cells die, but surviving cells can suffer damage resulting in long-term sensory dysfunction in the cortex. The cerebral cortex is the outer covering of the brain – the gray matter that covers hemispheres of the brain like a helmet. This is the part of the brain that receives sensory input, such as vision, hearing and touch, and areas of the cortex are also involved in more complex functions, such as memory, language, creativity, judgment and emotion.

The research team studied the long-term impact of cardiac arrest on the cortex in a rat model.  They measured sensory response and found that after oxygen deprivation, the sensory circuits in the cortex are less responsive with behavioral deficits. Their data suggest that cardiac arrest and resuscitation permanently affect cortical circuit function in survivors.

According to the American Heart Association, more than 350,000 Americans experienced out-of-hospital cardiac arrest last year. With bystander CPR, 46.1% survived.  “These findings lay the groundwork for further studies to pinpoint therapeutic targets to restore excitatory/inhibitory balance in the injured brain and mitigate sensory deficits later in life,” concludes Middleton.

The research team also included Drs. Daniel J. Simons, Robert S. B. Clark and Patrick M. Kochanek from the University of Pittsburgh School of Medicine and Drs. Jennifer W. Simmons and Michael Shoykhet from Washington University School of Medicine in St. Louis.

 

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O2 & Hyperbaric Oxygen Therapy Reverses Brain Damage In Drowned Toddler

 Leslie Capo, Director of Information Services 

Dr. Paul Harch, Clinical Professor and Director of Hyperbaric Medicine at LSU Health New Orleans School of Medicine, and Dr. Edward Fogarty, at the University of North Dakota School of Medicine, report a case of the reversal of brain volume loss in a two-year-old drowning victim unresponsive to all stimuli treated with normobaric oxygen (oxygen at sea level) and hyperbaric oxygen therapy (HBOT). The report is published in Medical Gas Research.

The two-year-old girl experienced cardiac arrest after a cold water drowning accident in a swimming pool. After resuscitation at Arkansas Children’s Hospital, MRI revealed deep gray matter injury and cerebral atrophy with gray and white matter loss. She had no speech, gait, or responsiveness to commands with constant squirming and head shaking at hospital discharge.

Dr. Harch was consulted, and because hyperbaric oxygen therapy was not available in the patient’s location, he began a bridging treatment to prevent permanent tissue degeneration until he could get the patient to a hyperbaric treatment center. Fifty-five days post-drowning, he began short duration treatment with 100% normobaric oxygen for 45 minutes twice a day through a nasal cannula. The patient became more alert, awake and stopped squirming. Her rate of neurological improvement increased with laughing, increased movement of arms, hands, grasp with the left hand, partial oral feeding, eye tracking and short-sequenced speech (pre-drowning speech level, but with diminished vocabulary).

The patient and family then traveled to New Orleans where 78 days post-drowning, Dr. Harch began treating her with hyperbaric oxygen therapy. She “dove” in a hyperbaric chamber for 45 minutes a day, five days a week for 40 sessions. At the beginning of each session, the patient showed visually apparent and/or physical examination-documented neurological improvement. After 10 HBOT sessions, the patient’s mother reported that her daughter was “near normal” except for gross motor function, and physical therapy was re-instituted. After 39 HBOT sessions, the patient exhibited assisted gait, speech level greater than pre-drowning, near normal motor function, normal cognition, improvement on nearly all neurological exam abnormalities, discontinuance of all medications, as well as residual emotional, gait and temperament deficits. Gait improvement was documented immediately upon returning home. An MRI at 27 days following HBOT session 40 and 162 days post-drowning demonstrated mild residual injury and near-complete reversal of cortical and white matter atrophy.

The synergy of increased oxygen and increased oxygen with pressure in the hormone-rich environment in a child’s growing brain is consistent with the synergy of growth hormones and hyperbaric oxygen caused by normobaric and hyperbaric oxygen-induced activation of genes that reduce inflammation and promote cell survival.

 

Aesculapian Society Awards 

The votes are in and the following faculty members and residents have been recognized by the Aesculapian Society, voted on by the medical students, for the Excellence in Teaching Award:

  • Fall, First Year Professor Award
    Dr. Jason Mussell (Cell Biology and Anatomy)
  • Spring, First Year Professor Award
    Dr. Mitzi Glover (Clinical Laboratory Science)
  • Fall, Second Year Professor Award
    Dr. Hamilton Farris (Neuroscience/Anatomy)
  • Spring, Second Year Professor Award
    Dr. Daniel Kapusta (Pharmacology)
  • Third Year Faculty Award
    Dr. Dean Lauret (Internal Medicine – Baton Rouge)
  • Fourth Year Faculty Award
    Dr. Fred Lopez (Medicine)
  • Junior Faculty Award
    Dr. Shane Guillory (Medicine)
  • Third Year Resident Award
    Dr. Katie Veron (Internal Medicine – Baton Rouge)
  • Fourth Year Resident Award
    Dr. Randy Rossignol (Internal Medicine – Baton Rouge)
  • Third Year Intern Award
    Dr. Matt Berlinger (Internal Medicine – Baton Rouge)
  • Fourth Year Intern Award
    Dr. Brandon Mong (Emergency Medicine – Baton Rouge)
  • Department Award
    Internal Medicine (Baton Rouge)

Lisa Peacock, M.D. Debates Universal Cystoscopy

Adapted from The American College of Obstetricians and Gynecologists Annual Clinical and Scientific Meeting Report

Although more prospective studies are needed, debaters leaned toward universal cystoscopy after hysterectomy performed with reconstructive surgery as opposed to selective cystoscopy.  Lisa M. Peacock, M.D. (Chair of Obstetrics and Gynecology at LSUHSC) took the pro stance during the debate “Routine Cystoscopy at the Time of Hysterectomy” while Rebecca Rogers, M.D. (Associate Chair for Clinical Integrations and Operations, Department of Women’s Health at the Dell Medical School at the University of Texas at Austin) took the opposing stance.

Dr. Peacock reviewed several studies and programs that examined overall detection rates with universal cystoscopy, including the largest multi-site study involving 839 patients.  Researchers at LSU SOM and Tulane University found that prior to cystoscopy, the ureteral injury detection rate was 6.7 percent and the bladder injury detection rate was 37.5 percent.  With cystoscopy, the overall detection rate increased to 97.4 percent.

Using this information and data from other sources Dr. Peacock argued that universal cystoscopy is now a mandated expectation of resident training and has very low complication rates. “The proponents against universal cystoscopy would say that you are going to give them UTIs, bladder and ureteral trauma, and they’re going to react to our contrast again, but I will tell you that after the five major studies that I’ve pulled that represent 5,283 patients, there was one complication.  The one complication was one you wouldn’t even think to occur: the institution [reporting this complication] had bought a new warming unit and they put their fluid in there, and it was too hot and they scalded the bladder.”

Dr. Rogers acknowledged that as an urogynecologist, she does perform cystoscopy so she can “sleep at night”.  To support the case against universal cystoscopy she shared complication concerns and a systematic review that looked at 79 studies and 41,000 hysterectomies.  With routine cystoscopy there was a five-fold increase in injury detection but no reduction in the number of postoperatively detected injuries.

Both doctors agreed that more research and cost analysis is needed in order to determine the value of universal cystoscopy.