Neuroprotective strategies for patients with acute myocardial infarction combined with hypoxic ischemic encephalopathy in the ICU

Abstract

Background: We investigated neuroprotective treatment strategies for patients with acute myocardial infarction (AMI) complicated with hypoxic ischemic encephalopathy (HIE) in the ICU.

Methods: The 83 cases diagnosed with secondary AMI were, for the first time, divided into an observation group (n = 43) and control group (n = 40). All of the patients underwent emergency or elective PCI. Patients in the control group were treated with mannitol to reduce intracranial pressure and cinepazide maleate to improve microcirculation in the brain as well as given a comprehensive treatment with oxygen inhalation, fluid infusion, acid-base imbalance correction and electrolyte disturbance. Patients in the observation group underwent conventional treatment combined with neuroprotective therapeutic strategies. The effects of the different treatment strategies were compared.

Results: Consciousness recovery time, reflex recovery time, muscle tension recovery time and duration of ICU stay were significantly shorter in the observation group compared with the control group (P < 0.05). After treatment, the jugular vein oxygen saturation (SjvO2) and blood lactate (JB-LA) levels of both groups were lower than before treatment and the cerebral oxygen utilization rate (O2UC) increased, with a significantly higher increase in the observation group (P < 0.05). After treatment, the activities of daily living (ADL) score was higher for both groups and the neural function defect (NIHS) score was lower.

Conclusion: The neuroprotective strategies of hypothermia and ganglioside administration assisted with hyperbaric oxygen was effective for treating AMI patients with HIE and may be worth clinical promotion.

Keywords: Acute myocardial infarction; Hypoxic ischemic encephalopathy; ICU; Neural protection.