Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Feb 7:16:1497046.
doi: 10.3389/fneur.2025.1497046. eCollection 2025.

Diurnal variation in brain injury after cardiac arrest and cardiopulmonary resuscitation

Fei Peng  1 , Fei Wang  1 , Bowen Gao  2 , Ping Sun  3
Affiliations

Diurnal variation in brain injury after cardiac arrest and cardiopulmonary resuscitation

Fei Peng et al. Front Neurol. .

Abstract

Background: Although the circadian rhythm is known to influence several neurological diseases and response to treatments, its potential impact on brain injury following cardiac arrest and cardiopulmonary resuscitation (CA/CPR) remains unclear.

Methods: We performed a retrospective observational study on out-of-hospital cardiac arrest (OHCA) cases that presented to the emergency department of our hospital between September 2022 and August 2024. Based on the CA/CPR onset time, all patients were divided into two cohorts: daytime and nighttime groups. The gray-to white-matter signal intensity ratio (GWR) was analyzed using brain computed tomography (CT) images. We used the Cerebral Performance Category (CPC) to estimate the neurological outcomes. C-reactive protein (CRP), white blood cell (WBC) count, and monocyte (MONO) count levels in the plasma were also analyzed.

Results: Our study included 138 patients, of whom 68 were subjected to CA/CPR during daytime (8:00 to 20:00) and the remaining 70 were subjected to CA/CPR during nighttime (20:00 to 8:00). The imaging data showed that GWR values were significantly lower among patients subjected to CA/CPR during nighttime compared to those who were subjected to CA/CPR during daytime. Consistently, lower survival rates were observed among nighttime CA/CPR survivors. The CPC results indicated that a greater number of patients who underwent CA/CPR during daytime were rated as class 1-2 on day 3, day 5, and day 7 after achieving return of spontaneous circulation (ROSC). In contrast, a larger proportion of CA/CPR survivors in the nighttime group were rated as class 5 at the same time points. Elevated levels of C-reactive protein, white blood cell count, and monocyte count were observed in the plasma of survivors who underwent nighttime CA/CPR.

Conclusion: We found that patients subjected to CA/CPR during nighttime (20:00-8:00) had worse neurological outcomes compared to those treated during daytime (8:00-20:00).

Keywords: brain injury; cardiac arrest; circadian rhythm; diurnal; ischemia–reperfusion; neurological outcomes.

PubMed Disclaimer

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Evaluation of brain injury after CA/CPR. (A) Representative brain computed tomography (CT) images of the patients after CA/CPR. The brain CT scans that showed signs of more severe brain injury revealed a greater loss of gray–white matter differentiation, which was reflected by a smaller GWR value. (B) Gray–white matter ratio (GWR) values were quantitatively analyzed (1.20 ± 0.07 vs.1.13 ± 0.07, p = 0.035, effect size = 0.24). (C) Survival rate of the patients with different CA/CPR onset times. *p < 0.05.
See this image and copyright information in PMC

References

    1. Ryu WS, Hong KS, Jeong SW, Park JE, Kim BJ, Kim JT, et al. . Association of ischemic stroke onset time with presenting severity, acute progression, and long-term outcome: a cohort study. PLoS Med. (2022) 19:e1003910. doi: 10.1371/journal.pmed.1003910, PMID: - DOI - PMC - PubMed
    1. Greif R, Bhanji F, Bigham BL, Bray J, Breckwoldt J, Cheng A, et al. . Education, implementation, and teams: 2020 international consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations. Circulation. (2020) 142:S222–s283. doi: 10.1161/CIR.0000000000000896, PMID: - DOI - PubMed
    1. Perkins GD, Callaway CW, Haywood K, Neumar RW, Lilja G, Rowland MJ, et al. . Brain injury after cardiac arrest. Lancet. (2021) 398:1269–78. doi: 10.1016/S0140-6736(21)00953-3, PMID: - DOI - PubMed
    1. Neves AR, Albuquerque T, Quintela T, Costa D. Circadian rhythm and disease: relationship, new insights, and future perspectives. J Cell Physiol. (2022) 237:3239–56. doi: 10.1002/jcp.30815, PMID: - DOI - PubMed
    1. Khan S, Nobili L, Khatami R, Loddenkemper T, Cajochen C, Dijk DJ, et al. . Circadian rhythm and epilepsy. Lancet Neurol. (2018) 17:1098–108. doi: 10.1016/S1474-4422(18)30335-1, PMID: - DOI - PubMed

LinkOut - more resources