Improved neurological outcome of perampanel for hypoxic-ischemic encephalopathy in patients after out-of- hospital cardiac arrest resuscitation

Purpose: Although the resuscitation rate for patients with out-of-hospital cardiac arrest (OHCA) in Japan is increasing due to the widespread use of automated external defibrillators (AEDs), the proportion of patients who can return to society remains low at approximately 7%. Many patients have poor neurological outcomes and cannot return to society because of post-resuscitation hypoxic-ischemic encephalopathy. While the resumption of cardiac rhythm is important for patients with OHCA, improving neurological outcomes and returning to society are also important. However, temperature management therapy has been introduced to improve neurological outcomes. This study investigated whether perampanel, an antiepileptic drug that provides neurological protection against stroke and head injury, could improve neurological outcomes in patients resuscitated after OHCA. Methods The participants included 33 patients with OHCA admitted to our hospital from January 2021 to June 2022 and 33 patients admitted before that time. Perampanel was administered to the patients in the intervention group immediately after resuscitation. We defined a Cerebral Performance Category (CPC) score of 1.2 as a good neurological outcome. Results There was no significant difference in neurological outcomes at intensive care unit (ICU) discharge between the intervention and non-intervention groups; however, neurological outcomes at hospital discharge were significantly better in the intervention group (P = 0.01). Conclusion The α-amino-3-hydroxyl-5-methyl-4-isoxazole-propionate (AMPA) receptor inhibitory and neuronal protective effects of perampanel may have inhibited the progression of hypoxic-ischemic encephalopathy, which develops after the resumption of cardiac rhythm, and suppressed neuronal damage. Early administration of perampanel after resuscitation of patients with OHCA may improve neurological outcomes.