Treatment for cerebral recovery after cardiac arrest
Sjoukje Nutma is a PhD student in the Department of Clinical Neurophysiology. Promotors are prof.dr. J. Hofmeijer and prof.dr.ir. M.J.A.M. van Putten from the Faculty of Science & Technology.
Neurological recovery after cardiac arrest remains a major clinical challenge. Although initial resuscitation may be successful, many patients remain comatose due to global brain injury. Despite the growing urgency to improve outcomes, current treatment options offer limited benefit. This research addresses that gap by critically evaluating existing strategies and exploring new, targeted approaches to enhance neurological recovery.
The thesis opens with a review of neuroprotective interventions studied to date. Despite extensive research into therapies such as temperature control and pharmacological agents, no approach has consistently improved outcomes. These findings highlight the need for more personalised strategies, based on reliable neurological indicators and standardised outcome measures.
We also examined the potential for long-term recovery in severely impaired survivors after cardiac arrest. The findings showed that most patients with severe neurological deficits at six months did not regain independence over time and continued to experience major physical and cognitive limitations. This underscores the importance of shifting focus from solely cardiac rehabilitation to comprehensive brain rehabilitation.
We further assessed whether myoclonus in comatose patients is responsive to antiseizure treatment. The findings showed no benefit from treatment, indicating that while myoclonus is a marker of severe brain injury, it does not represent a modifiable treatment target.
Targeted temperature management (TTM), commonly applied in clinical practice, failed to show benefit in the general population of comatose patients. However, this research revealed that TTM at 33 °C may improve outcomes in patients with moderate encephalopathy when stratified based on EEG-defined severity of brain injury. These findings support a more selective approach, aligning treatment with individual patient profiles rather than a one-size-fits-all model.
The potential of acylated ghrelin, a hormone involved in energy balance and cognitive processes, formed the central focus of the experimental work in this dissertation. During my research, I coordinated a large multicentre randomized controlled trial across three hospitals to study the effects of high-dose intravenous ghrelin in comatose cardiac arrest patients. Treatment was started within twelve hours and continued for one week. The results showed a consistent shift towards better neurological outcomes and reduced levels of brain injury biomarkers in the treatment group. While additional research is required, these findings suggest that ghrelin may represent a promising therapeutic strategy to support early brain recovery.
This dissertation advocates for a more personalised and brain-focused approach to post-cardiac arrest care. It demonstrates how stratification based on neurological profiles, combined with thoughtful clinical innovation, can help guide more effective and patient-centred treatment strategies.
