Clinical trials in brain injury after cardiac arrest

Total circulatory failure with cardiac arrest injures both brain and extracerebral organs. The injury leads to complex adaptive and maladaptive responses at the level of cells, tissues, organs, and ultimately the organism. The primary injury in specific organs leads to secondary effects on other organs, which can worsen the brain and heart injury. The complex interplay among the heart, brain, vasculature, gastrointestinal tract, muscle, inflammatory system, coagulation system, and other organs necessitates a multidisciplinary team who can address multiorgan-integrated pathophysiology of injury. Treatments may include induced moderate hypothermia, anti-inflammatory agents, free radical scavengers, thrombolytic agents, and genetic manipulation of gene expression. The expanse of controlled trials primarily targeting brain injury for global ischemia related to cardiac arrest started with the Brain Resuscitation Clinical Trials (BRCTs) in 1986 to the more recent use of moderate hypothermia by the Hypothermia After Cardiac Arrest (HACA) Study Group and Australian groups in 2002. Many other controlled clinical trials were undertaken in the intervening period targeting numerous factors in the injury cascade of brain injury from cardiac arrest. & copy; 2006