Predicting and Precisely Defining Neurological Recovery after Cardiac Arrest

J. Gordon Boyd, John Muscedere, Michael Kawaja, Stephen Scott

Cardiac arrest affects over 50 000 Canadians each year. While only ~10% of these individuals are successfully resuscitated from their initial event, less than half of those survivors will survive their subsequent hospital stay. Among those who survive their cardiac arrest, the neurologic recovery can lie anywhere on the spectrum from completely normal to persistent vegetative state. Unfortunately, there is no reliable way to predict neurological recovery after cardiac arrest, especially within the first few days. The purpose of this research program is twofold. First, we propose that two-dimensional gel electrophoresis coupled with mass spectrometry is a feasible proteomic strategy to identify novel serum biomarkers that will correlate with neurologic recovery after cardiac arrest. Our preliminary prospective cohort study of 10 patients has demonstrated that this proteomic technique is a feasible strategy to identify high abundancy, acute phase reactant proteins (such as cell free hemoglobin and haptoglobin) in the serum of patients after cardiac arrest. We are currently refining our proteomic techniques, and will be assessing serum depleted of these high abundancy proteins. The second facet of this research program is to better define the degree of neurologic recovery among survivors of cardiac arrest with the KINARM, a robotic exoskeleton that provides a quantitative assessment of sensorimotor control of the upper limbs. We propose that the KINARM will provide unique insight into the mechanisms by which the brain recovers from the global hypoxic-ischemic injury that occurs after cardiac arrest. We will test the hypothesis that neurological dysfunction identified using the KINARM will correlate with non-invasive measures of cerebral perfusion after cardiac arrest, as well as quality of life after cardiac arrest.