Patrick J. Coppler, David J. Gagnon, Katharyn L. Flickinger, Jonathan Elmer, Clifton W. Callaway, Francis X. Guyette, Ankur Doshi, Alexis Steinberg, Cameron Dezfulian, Ari L. Moskowitz, Michael Donnino, Teresa L May, David B Seder, Jon C. Rittenberger
Clin Exp Emerg Med 2024;11(2):205-212. Published online January 29, 2024
Objective We hypothesized that the administration of amantadine would increase awakening of comatose patients resuscitated from cardiac arrest. Methods We performed a prospective, randomized, controlled pilot trial, randomizing subjects to amantadine 100 mg twice daily or placebo for up to 7 days. The study drug was administered between 72 and 120 hours after resuscitation and patients with absent N20 cortical responses, early cerebral edema, or ongoing malignant electroencephalography patterns were excluded. Our primary outcome was awakening, defined as following two-step commands, within 28 days of cardiac arrest. Secondary outcomes included length of stay, awakening, time to awakening, and neurologic outcome measured by Cerebral Performance Category at hospital discharge. We compared the proportion of subjects awakening and hospital survival using Fisher exact tests and time to awakening and hospital length of stay using Wilcoxon rank sum tests. Results After 2 years, we stopped the study due to slow enrollment and lapse of funding. We enrolled 14 subjects (12% of goal enrollment), seven in the amantadine group and seven in the placebo group. The proportion of patients who awakened within 28 days after cardiac arrest did not differ between amantadine (n=2, 28.6%) and placebo groups (n=3, 42.9%; P>0.99). There were no differences in secondary outcomes. Study medication was stopped in three subjects (21.4%). Adverse events included a recurrence of seizures (n=2; 14.3%), both of which occurred in the placebo group.
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Etiology-specific prognostic value of ultra-early diffusion-weighted MRI after out-of-hospital cardiac arrest: a multicenter cohort study Jin Hong Min, Yeonho You, Jung Soo Park, Changshin Kang, Hyun Shik Ryu, Wonjoon Jeong, Se Kwang Oh, So Young Jeon, In Ho Lee, Hye Seon Jeong, Sung Phil Chung, Rachel Beekman, Byung Kook Lee, Dong Hun Lee Critical Care.2026;[Epub] CrossRef
Effect of Amantadine Therapy on Neurological and Laboratory Outcomes in Post-Cardiac Arrest Intensive Care Patients: A Retrospective Analysis Mizgin Duz Taymur, Başak Pehlivan, Veli Fahri Pehlivan, Erdoğan Duran Harran Üniversitesi Tıp Fakültesi Dergisi.2026; 23(1): 34. CrossRef
Amantadine Continuation After Hospital Discharge for Acute Stroke Requiring Inpatient Rehabilitation: A Long-term Follow-up Study Haley R. Torr, Sara Penrod, Jennifer Cote, Sara E. Hanken, Stephanie C. Chan, Richard R. Riker, Angela Leclerc, Teresa L. May, David B. Seder, David J. Gagnon Archives of Rehabilitation Research and Clinical Translation.2025; 7(2): 100459. CrossRef
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European Resuscitation Council and European Society of Intensive Care Medicine guidelines 2025: post-resuscitation care Jerry P. Nolan, Claudio Sandroni, Alain Cariou, Tobias Cronberg, Sonia D’Arrigo, Kirstie Haywood, Astrid Hoedemaekers, Gisela Lilja, Nikolaos Nikolaou, Theresa Mariero Olasveengen, Chiara Robba, Markus B. Skrifvars, Paul Swindell, Jasmeet Soar Intensive Care Medicine.2025; 51(12): 2213. CrossRef
Advanced Life Support: 2025 International Liaison Committee on Resuscitation Consensus on Science With Treatment Recommendations Ian R. Drennan, Katherine M. Berg, Bernd W. Böttiger, Yew Woon Chia, Keith Couper, Conor Crowley, Sonia D’Arrigo, Charles D. Deakin, Shannon M. Fernando, Rakesh Garg, Asger Granfeldt, Brian Grunau, Karen G. Hirsch, Mathias J. Holmberg, Peter J. Kudenchuk, Circulation.2025;[Epub] CrossRef
European Resuscitation Council and European Society of Intensive Care Medicine Guidelines 2025 Post-Resuscitation Care Jerry P. Nolan, Claudio Sandroni, Alain Cariou, Tobias Cronberg, Sonia D’Arrigo, Kirstie Haywood, Astrid Hoedemaekers, Gisela Lilja, Nikolaos Nikolaou, Theresa Mariero Olasveengen, Chiara Robba, Markus B. Skrifvars, Paul Swindell, Jasmeet Soar Resuscitation.2025; 215: 110809. CrossRef
Advanced Life Support: 2025 International Liaison Committee on Resuscitation Consensus on Science With Treatment Recommendations Ian R. Drennan, Katherine M. Berg, Bernd W. Böttiger, Yew Woon Chia, Keith Couper, Conor Crowley, Sonia D’Arrigo, Charles D. Deakin, Shannon M. Fernando, Rakesh Garg, Asger Granfeldt, Brian Grunau, Karen G. Hirsch, Mathias J. Holmberg, Peter J. Kudenchuk, Resuscitation.2025; 215: 110806. CrossRef
Drug therapy versus placebo or usual care for comatose survivors of cardiac arrest; a systematic review with meta-analysis Peter J. McGuigan, Ellen Pauley, Glenn Eastwood, Leanne M.C. Hays, Janus C. Jakobsen, Marion Moseby-Knappe, Alistair D. Nichol, Niklas Nielsen, Markus B. Skrifvars, Bronagh Blackwood, Daniel F. McAuley Resuscitation.2024; 205: 110431. CrossRef
A 34-year-old male was brought to the hospital with a chest gunshot wound. Pulseless upon arrival, blood pressure was absent for 10 minutes. A thoracotomy resulted in return of spontaneous circulation. On hospital day 5, with brainstem reflexes present, he was unresponsive to call or pain, exhibited generalized hyperreflexia and bilateral Babinskys. Median nerve somatosensory evoked potentials (mSSEPs) and brainstem auditory evoked potentials were obtained. International Federation of Clinical Neurophysiology recommendations for mSSEPs and brainstem auditory evoked potentials were followed. Despite absence of the N20 responses from cortical mSSEPs no withdrawal from care was agreed upon. After awaking on day 7, mSSEPs were repeated and present. The patient survived and was discharged with minor deficits. Bilateral absence of N20 responses from mSSEPs performed beyond 48 hours after resuscitation from cardiac arrest is highly associated with bad neurological outcomes. However, variation due to hypothermia, noisy signals, medications, and brain hypo-perfusion must be taken into account.
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A Retrospective Study on Correlations Between EEG Signals (N20, Spectral Entropy, and Alpha Variability) and Prognosis of Traumatic Brain Injury Xia Liu, Mengxu Qiao, Qi Liu, Meilin Ai, Jing Deng, Jian Wang, Haojun Yang, Li Huang Biomedicines.2026; 14(5): 1033. CrossRef
Patrick J. Coppler, Benjamin S. Abella, Clifton W. Callaway, Minjung Kathy Chae, Seung Pill Choi, Jonathan Elmer, Won Young Kim, Young-Min Kim, Michael Kurz, Joo Suk Oh, Joshua C. Reynolds, Jon C. Rittenberger, Kelly N. Sawyer, Chun Song Youn, Byung Kook Lee, David F. Gaieski, on behalf of the Korean Hypothermia Network Investigators and the National Post-Arrest Research Consortium
Clin Exp Emerg Med 2018;5(2):100-106. Published online April 30, 2018
Objective A growing interest in extracorporeal cardiopulmonary resuscitation (ECPR) as a rescue strategy for refractory adult out-of-hospital cardiac arrest (OHCA) currently exists. This study aims to determine current standards of care and practice variation for ECPR patients in the USA and Korea.
Methods In December 2015, we surveyed centers from the Korean Hypothermia Network (KORHN) Investigators and the US National Post-Arrest Research Consortium (NPARC) on current targeted temperature management and ECPR practices. This project analyzes the subsection of questions addressing ECPR practices. We summarized survey results using descriptive statistics.
Results Overall, 9 KORHN and 4 NPARC centers reported having ECPR programs and had complete survey data available. Two KORHN centers utilized extracorporeal membrane oxygenation only for postarrest circulatory support in patients with refractory shock and were excluded from further analysis. Centers with available ECPR generally saw a high volume of OHCA patients (10/11 centers care for >75 OHCA a year). Location of, and providers trained for cannulation varied across centers. All centers in both countries (KORHN 7/7, NPARC 4/4) treated comatose ECPR patients with targeted temperature management. All NPARC centers and four of seven KORHN centers reported having a standardized hospital protocol for ECPR. Upper age cutoff for eligibility ranged from 60 to 75 years. No absolute contraindications were unanimous among centers.
Conclusion A wide variability in practice patterns exist between centers performing ECPR for refractory OHCA in the US and Korea. Standardized protocols and shared research databases might inform best practices, improve outcomes, and provide a foundation for prospective studies.
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