Effect of Xingnaojing Injection on Neurological Outcomes in patients with Extracorporeal cardiopulmonary resuscitation: A single-center retrospective cohort study
Authors: Liao Xiaozu , Cheng Zhou , Zhong Shi , Li Binfei 
Published: October 2024

Background: Patients undergoing extracorporeal cardiopulmonary resuscitation (ECPR) have poor neurological prognoses and low survival rates. Xingnaojing injection (XNJ) is widely used in the acute phase of ischemic stroke. This study aimed to investigate the effects of XNJ on neurological outcomes in patients receiving ECPR. Methods: Medical data of all patients who underwent ECPR at Zhongshan People's Hospital from January 2023 to March 2024 were collected. In this retrospective cohort study, patients were divided into XNJ and non-XNJ groups according to whether or not they used XNJ. Baseline data of patients were collected, including serum neuron-specific enolase (NSE) S-100 protein, TNF-α and IL-6 at 1 h, 24 h, 48 h and 72 h after extracorporeal membrane oxygenation (ECMO). The optimal Glasgow Coma Scale (GCS)at 24 and 72 hours after ECMO and the outcomes of neurological function and prognosis at discharge were evaluated. Univariate and multivariate logistic regressions were used to analyze the risk factors affecting patient prognosis. Results: A total of 44 patients were included in this study; 22 in each group. The patients were 47 (38.0, 57.5) years old, the CPR time before ECMO was 30 (22, 50) min, and the APACHE II score was 28 (20, 31) points. ECMO assisted 96 (72,144) hours, ICU 7.5 (5, 12) days, 14.5 (6.3, 24) days in the hospital, 50% survived discharge, and 40.9% of patients had favorable neurological outcome at discharge. The GCSscores at 24 and 72 hours after ECMO were (9(3, 13) vs 9(3, 15), p=0.68), (12.5 (3, 15) vs 10 (3, 15), p=0.13), respectively. There was no statistically significant difference in Cerebral Performance Category (CPC) scores at discharge, p=0.68. The rate of favorable neurological outcomes at discharge between the XNJ and non-XNJ groups was 40.9% vs 40.9%, p=0.62, and there was no significant difference between the two groups in terms of survival and discharge (45.6% vs 54.5%, p=0.76). Serum S100 and NSE proteins, which are markers of brain injury, increased within 24 hours and decreased 48 hours later in both groups. The expression of S100 protein in the XNJ group at 24, 48, and 72 hours was lower than that in the non-XNJ group (p<0.05). The expression of NSE protein in the XNJ group at 48 and 72 hours was lower than that in the non-XNJ group (p<0.05). Serum TNF-α and IL-6, markers of inflammation in both groups, showed a decreasing trend at 24 hours after ECMO. The expression of serum TNF-α at 24 and 48 hours was lower in the XNJ group (p<0.05). The expression of IL-6 at 48 and 72 hours was lower in the XNJ group (p<0.05). The lactate level before ECMO (1.353 [1.020-1.796], p=0.036) was an independent risk factor for the prognosis of ECMO-assisted patients. ROC curve of pre-ECMO lactate level (AUC=0.75 (0.61-0.91), p<0.01. Conclusion: XNJ may alleviate brain injury and inhibit the inflammatory response in patients undergoing ECPR but may not improve the neurological function and survival of patients at discharge.