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ORIGINAL RESEARCH article

Front. Neurol.
Sec. Neurocritical and Neurohospitalist Care
Volume 16 - 2025 | doi: 10.3389/fneur.2025.1497046

The diurnal variation of brain injury after cardiac arrest and cardiopulmonary resuscitation

Provisionally accepted
Fei Peng Fei Peng 1Fei Wang Fei Wang 1Bowen Gao Bowen Gao 2Ping Sun Ping Sun 3*
  • 1 Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Chengdu, China
  • 2 Chengdu Medical College, Chengdu, Sichuan, China
  • 3 Tangdu Hospital, Air Force Medical University, Xi'an, Shaanxi Province, China

The final, formatted version of the article will be published soon.

    Background: Although circadian rhythm is known to have an impact on several neurological diseases and the response to treatments, its potential impact on brain injury following cardiac arrest and cardiopulmonary resuscitation (CA/CPR) remains unknown.We performed a retrospective observational study of out-of-hospital cardiac arrest (OHCA) cases presenting at emergency department in our hospital between September 2022 and August 2024. All patients were divided into cohorts of daytime and nighttime group according to the CA/CPR onset time. The gray to white matter signal intensity ratio (GWR) was analyzed using brain computed tomography (CT) images. We used Cerebral Performance Categories (CPC) to estimate the neurological outcomes. C-reactive protein (CRP), white blood cell count (WBC), and monocyte count (MONO) levels in plasma were analyzed.Results: There were 138 patients included in our study, among which 68 patients were subjected to CA/CPR during daytime (8:00 to 20:00), and the other 70 patients were subjected to CA/CPR during nighttime (20:00 to 8:00). The imaging data showed that GWR were significantly lower among patients subjected to CA/CPR during the nighttime than those in the daytime. Consistently, lower survival rates were observed in nighttime CA/CPR survivors. The results of CPC indicated that more patients subjected to CA/CPR during the daytime were rated as class 1-2 at day 3, day 5, and day 7 after return of spontaneous circulation (ROSC), compared with those suffered CA/CPR during the nighttime. In contrast to this, more CA/CPR survivors in the nighttime group were rated as class 5 at the same time points. Elevated C-reactive protein, white blood cell count, and monocyte count levels in plasma of nighttime CA/CPR survivors were observed.We found that patients subjected to CA/CPR during nighttime (20:00-8:00) have poorer neurological outcomes than those suffered CA/CPR at daytime (8:00-20:00).

    Keywords: Circadian Rhythm, diurnal, Cardiac arrest, Brain Injury, neurological outcomes, ischemia/reperfusion

    Received: 17 Sep 2024; Accepted: 22 Jan 2025.

    Copyright: © 2025 Peng, Wang, Gao and Sun. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence: Ping Sun, Tangdu Hospital, Air Force Medical University, Xi'an, Shaanxi Province, China

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