Experimental evidence shows that Cyclosporin A reduces traumatic and ischaemic/reperfusion injury to brain tissue. Authors test the hypothesis that survivors treated by Cyclosporin A at the time of cardiac arrest will have better neurodevelopmental outcome. They reviewed retrospectively outcome of cardiopulmonary resuscitation between children with congenital or acquired heart disease, and children who underwent cardiac transplantation and were treated with Cyclosporin A in tertiary pediatric cardiac center between 1990-2001. Patients surviving to 3 months following cardiac arrest lasting over 7 minutes were assessed using 2 neurodevelopmental scoring systems (Pediatric Overall, and Cerebral, Performance Category scales). There were 2 survivors from 69 non-transplant patients (3%) and 8 survivors from 15 transplant patients (53%; p<0.001). These data show relative risk reduction of mortality in patients with transplanted heart and treated with Cyclosporin A at the time of cardiac arrest at 52%, odds ratio 0.03 (95% CI 0.005-0.15) and number needed to treat 2 (95% CI 1-4). Neurodevelopmental scores did not change in transplant cardiac arrest survivors 3 months after hospital discharge (median 1, range 1-3) from their pre-arrest scores (median 1, range 1-3; p=0.22). Authors believe that their results support a neuroprotective role of Cyclosporin A in pediatric clinical practice. Their longer than usual resuscitation efforts in some of the patients allowed themto observe these interesting clinical results.

        Key words: reperfusion injury, neuroprotection, Cyclosporin A, heart transplantation