Coma Research Today is a free monthly online journal that collates and summarizes the latest research about Coma, including details on causes, diabetes, gcs, recovery.

Complement-dependent inflammation and injury in a murine model of brain dead donor hearts.

Atkinson C, Varela JC, Tomlinson S

Department of Microbiology and Immunology, Children's Research Institute, Medical University of South Carolina, Charleston, SC 29425, USA.

RATIONALE: Donor brain death (BD) is an unavoidable occurrence in heart transplantation and results in profound physiological derangements that render the heart more susceptible to ischemia/reperfusion injury in the recipient and likely has negative long-term consequences to allograft survival. OBJECTIVE: We developed a novel mouse model of BD and investigated the role of complement in BD-induced myocardial inflammation and injury. METHODS AND RESULTS: BD was induced by inflation of a balloon catheter in the cranial cavity. BD in wild-type mice resulted in a significant increase in serum concentrations of the complement activation product complement component (C)3a, and immunohistochemical analysis of heart sections demonstrated C3 deposition on the vascular endothelium and surrounding myocytes. Following induction of BD in complement (C3)-deficient mice, cardiac troponin levels, and histological evidence of injury were significantly reduced compared to wild-type mice. C3 deficiency was also associated with reduced myocardial leukocyte infiltration and reduced or absent expression of P-selectin, intercellular adhesion molecule-1, vascular cell adhesion molecule-1, tumor necrosis factor-alpha, and interleukin-1beta. CONCLUSIONS: These data indicate an important role for complement in BD-induced inflammation and injury and suggest that a complement inhibitory strategy applied to the donor (in addition to the recipient) may provide graft protection.

Published 20 November 2009 in Circ Res, 105(11): 1094-101.
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Articles on Coma published 3 November 2009:

Somatosensory evoked potentials during mild hypothermia after cardiopulmonary resuscitation.   Neurology, 73(18): 1457-61.

OBJECTIVE: In patients who remain in a coma after cardiopulmonary resuscitation (CPR), the bilateral absence of cortical N20 responses of median nerve somatosensory evoked potentials (SSEP) 24 hours after admission invariably correlates with a poor neurologic outcome. Nowadays, CPR patients are treated with mild hypothermia, with simultaneously administered sedative drugs, hampering clinical neurologic assessment. We investigated whether SSEP performed during hypothermia can reliably predict a ... [Abstract] [Full-text]

Articles on Coma published 2 September 2009:

Cardiogenic oscillation and ventilator autotriggering in brain-dead patients: a case series.   Am J Crit Care, 18(5): 496, 488-95.

Brain death is manifested by a flaccid, areflexic patient on assessment of brain function with fixed and dilated pupils at midpoint, loss of consciousness, no response to stimulation, loss of brainstem reflexes, and apnea. A lesion or clinical state responsible for the loss of consciousness must be found. An integral part of clinical evaluation of brain death is apnea testing, which indicates complete loss of brainstem function and respiratory drive. Ventilator triggering or overbreathing the ... [Abstract] [Full-text]

Residual brain viability, evaluated by (99m)Tc-ECD SPECT, in patients with suspected brain death and with confounding clinical factors.   Nucl Med Commun, 30(10): 815-21.

BACKGROUND: In 1968, the Harvard criteria for brain death diagnosis were introduced in clinical practice. These include no movements or breathing, no reflexes, and flat electroencephalogram in the absence of confounding factors, including hypothermia, drugs, electrolyte, and endocrine disturbances. When confounding factors occur, confirmatory tests documenting the absence of cerebral blood flow, such as cerebral angiogram, transcranial Doppler sonography, computed tomography angiography, and ... [Abstract] [Full-text]

Articles on Coma published 24 August 2009:

Coma resulting from spontaneous intracranial hypotension treated with the epidural blood patch in the Trendelenburg position pre-medicated with acetazolamide.   Clin Neurol Neurosurg, 111(8): 699-702.

A 62-year-old man had a new onset of severe, orthostatic headache which eventually progressed to a stupor and a coma 3 weeks later. A computed tomography (CT) scan showed bilateral chronic subdural haematoma and magnetic resonance imaging (MRI) of the brain showed the typical findings of spontaneous intracranial hypotension (SIH). After pre-medication with acetazolamide, he was treated with three lumbar autologous epidural blood patches (EBPs) and kept in the Trendelenburg position, with full ... [Abstract] [Full-text]

Articles on Coma published 11 August 2009:

Avermectin intoxication with coma, myoclonus, and polyneuropathy.   Clin Toxicol (Phila), 47(7): 686-8.

INTRODUCTION: Avermectin has been used in the control of parasites and insects. Severe poisoning symptoms in humans include altered mental status, hypotension, and respiratory failure. CASE REPORT: We describe a case of acute avermectin intoxication at a very high dose (414.2 mg/kg) who presented with coma, myoclonus, and polyneuropathy after oral ingestion. DISCUSSION: The symptoms are supposed to be associated directly with the avermectin poisoning and possibly with the toxicity of solvents ... [Abstract] [Full-text]

Articles on Coma published 7 August 2009:

The corrected QT interval before and after heart transplantation.   Am J Cardiol, 104(4): 596-601.

Heart donor candidates have severe neurologic injuries that have been associated with significant prolongation of the corrected QT (QTc) interval. Screening for an underlying abnormality of cardiac repolarization such as the long-QT syndrome thus becomes difficult. The aims of this study were to establish normal values and determine factors associated with prolongation of pre- and post-transplantation QTc intervals in a large cohort of heart transplantation donors and recipients. The medical ... [Abstract] [Full-text]

Articles on Coma published 3 August 2009:

Validity of the FOUR score coma scale in the medical intensive care unit.   Mayo Clin Proc, 84(8): 694-701.

OBJECTIVE: To evaluate the validity of the FOUR (Full Outline of UnResponsiveness) score (ranging from 0 to 16), a new coma scale consisting of 4 components (eye response, motor response, brainstem reflexes, and respiration pattern), when used by the staff members of a medical intensive care unit (ICU). PATIENTS AND METHODS: This interobserver agreement study prospectively evaluated the use of the FOUR score to describe the condition of 100 critically ill patients from May 1, 2007, to April 30, ... [Abstract] [Full-text]

Articles on Coma published 27 July 2009:

Brain death effects on catecholamine levels and subsequent cardiac damage assessed in organ donors.   J Heart Lung Transplant, 28(8): 815-20.

BACKGROUND: Brain death (BD) causes hemodynamic and neuroendocrine alterations including a catecholamine surge, which in turn causes histologic lesions in cardiac muscle such as contraction bands, focal mononuclear cell infiltrates and cardiomyocyte necrosis. These changes are likely to compromise heart function and could therefore also affect the graft response after heart transplantation. This study was designed to examine the catecholamine surge, the catecholamine release pattern and the ... [Abstract] [Full-text]

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