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Efficacy of Citicoline as a Neuroprotector in children with post cardiac arrest: a randomized controlled clinical
Abeer Salamah1, Mostafa Mehrez2, Amany Faheem3
1Pediatric Department, Kafr Elsheikh University, Kafr Elsheikh, Egypt.
Insights
Citicoline (CDP-choline) shows neuroprotective effects in children after cardiac arrest. This treatment improved neurological function and reduced seizures, mortality, and hospital stay in pediatric patients.
Area of Science:
- Neurology
- Pediatric Critical Care
Background:
- Brain hypoxia following cardiac arrest can cause neuronal cell membrane damage.
- Citicoline (CDP-choline) is essential for cell membrane synthesis and has shown reparative effects in adult stroke studies.
Purpose of the Study:
- To evaluate the neuroprotective potential of citicoline in children who have experienced cardiac arrest.
- This study aimed to assess citicoline's impact on neurological outcomes and biomarkers in pediatric post-cardiac arrest patients.
Main Methods:
- A randomized controlled trial involving 80 children surviving in-hospital cardiac arrest.
- Participants were divided into two groups: one receiving citicoline intravenously for 6 weeks, and a control group receiving standard care.
- Outcomes measured included Glasgow Coma Scale (GCS), modified Rankin Scale (mRS) for children, seizure activity, and serum neuron-specific enolase (NSE) levels.
Main Results:
- Citicoline administration significantly improved GCS and mRS scores compared to the control group.
- The citicoline group experienced decreased seizure frequency and duration, reduced mortality, and shorter PICU and hospital stays.
- Serum NSE levels significantly decreased in the citicoline group, indicating reduced neuronal damage.
Conclusions:
- Citicoline demonstrates promising neuroprotective properties in pediatric patients following cardiac arrest.
- The drug appears safe and effective in improving neurological function and reducing adverse outcomes in this vulnerable population.
Abstract:
Brain hypoxia after cardiac arrest leads to damage of the neuronal cell membrane. Citicoline is necessary for the synthesis of cell membrane. We planned to assess the neuroprotective effect of citicoline in children after cardiac arrest. This randomized controlled trial was carried out at pediatric intensive care units (PICU) and surgical ICU at Tanta university hospital on 80 consecutive children surviving in-hospital cardiac arrest who were subdivided into two groups. Group I (citicoline group) included 40 children with post-cardiac arrest who received citicoline 10 mg /kg /12 h IV for 6 weeks plus other supportive measures and group II (control group) included 40 children with post-cardiac arrest who were managed with only supportive measures. All patients were evaluated for Glasgow coma score (GCS), modified Rankin scale (mRS) for children, seizures frequency, type and duration, and serum neuron-specific enolase (NSE) before and 3 months after the treatment. GCS and mRS significantly improved in citicholine group compared to the control group. Seizure frequency and duration, mortality, PICU and hospital stay significantly decreased in citicholine group compared to the control group. Serum NSE levels significantly decreased in citicholine group only. No side effects were recorded.Conclusion: Citicoline is a promising neuroprotective drug in children with post-cardiac arrest.Trial Registration: The study was registered at Pan African Clinical Trials Registry (PACTR) www.pactr.samrc.ac.za with trial number PACTR201907742119058. What is known? • Post-resuscitation brain injury is one of the major complications that can lead to death or disability. • CDP-choline has been studied for acute ischemic stroke in several adult studies because of its reparative effect. What is new? • Our study was the first in pediatrics that assessed the neuroprotective effect of CDP-choline on the brain in children after cardiac arrest. • We found that Citicoline is a promising neuroprotective drug in children with post-cardiac arrest.
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