To the editor;
I read with great interest the article published by Ko et al., which was about usefulness of therapeutic hypothermia to improve survival in patients with out-of-hospital cardiac arrest. The authors reported that in hospital survival and neurlogic functions at discharge were better in the therapeutic hypotermia performed group.1
Therapeutic hypothermia is the only known recommended treatment to reduce neurologic ischemic injury and improve survival in patients with cardiac arrest.2 Seizure is a common manifestation of ischemic brain injury and it is related with worse outcomes. In animal studies; adding valproic acid on therapeutic hypothermia resulted in better survival and neurological outcomes than treatment with therapeutic hypothermia only in ressuciated rats due to asphyxial cardiac arrest.3 In another study; it is demonstrated that antiepileptic drugs have beneficial effects on nerulogic functions depending on the presence of background cortical acitivity detected by electroencephalograpy in patients with cardiac arrest.4
Primary percutaneous coronary intervention (PCI) is the preferred treatment in patients with myocardial infarction with ST segment elevation (STEMI). Multivessel disease can be detected in a part of patients with STEMI and intervention to lesions other than culprit lesion is onflicting. A recent study (COMPLETE trial) revealed that complete revascularization was superior to culprit-lesion-only PCI in reducing the risk of cardiovascular death and recurrent myocardial infarction.5
To conclude; both the use of antiepileptic drug use and complete revascularization have beneficial effects on outcomes after cardiac arrest including neurologic functions and survival. Therefore, we think that it could be better if the antiepileptic drug use and revascularization type (complete vs. culprit-lesion-only) were also evaluated in the present study.
REFERENCES
- 1.Ko PY, Wang LL, Chou YJ, et al. Usefulness of therapeutic hypothermia to improve survival in out-of-hospital cardiac arrest. Acta Cardiol Sin. 2019;35:394–401. doi: 10.6515/ACS.201907_35(4).20190113A. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Bernard SA, Gray TW, Buist MD, et al. Treatment of comatose survivors of out-of-hospital cardiac arrest with induced hypo-thermia. N Engl J Med. 2002;346:557–563. doi: 10.1056/NEJMoa003289. [DOI] [PubMed] [Google Scholar]
- 3.Oh JS, Tulasi J, Xiaodan R, et al. Valproic acid combined with postcardiac arrest hypothermic-targeted temperature management prevents delayed seizures and improves survival in a rat cardiac arrest model. Crit Care Med. 2017;45:e1149–e1156. doi: 10.1097/CCM.0000000000002690. [DOI] [PubMed] [Google Scholar]
- 4.Solanki P, Coppler PJ, Kvaløy JT, et al. Association of antiepileptic drugs with resolution of epileptiform activity after cardiac arrest. Resuscitation. 2019;142:82–90. doi: 10.1016/j.resuscitation.2019.07.007. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 5.Mehta SR, Wood DA, Storey RF, et al. Complete revascularizatiom with multivessel PCI for myocardial infarction. . N Engl J Med. 2019. [Epub ahead of print] doi: 10.1056/NEJMc2000278. [DOI] [PubMed] [Google Scholar]