Ayyappan Unnithan AK. Update on hypoxic-ischemic brain injury: Prognosis and management. World J Methodol 2026; 16(1): 110342 [DOI: 10.5662/wjm.v16.i1.110342]
Corresponding Author of This Article
Ajaya Kumar Ayyappan Unnithan, Assistant Professor, Department of Neurosurgery, Azeezia Medical College Hospital, Meeyannoor P.O., Kollam 691537, Kerala, India. drajayakumara@gmail.com
Research Domain of This Article
Medicine, General & Internal
Article-Type of This Article
Minireviews
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World J Methodol. Mar 20, 2026; 16(1): 110342 Published online Mar 20, 2026. doi: 10.5662/wjm.v16.i1.110342
Update on hypoxic-ischemic brain injury: Prognosis and management
Ajaya Kumar Ayyappan Unnithan
Ajaya Kumar Ayyappan Unnithan, Department of Neurosurgery, Azeezia Medical College Hospital, Kollam 691537, Kerala, India
Author contributions: Unnithan AKA conceptualized, wrote, and revised the manuscript.
Conflict-of-interest statement: The authors report no relevant conflicts of interest for this article.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ajaya Kumar Ayyappan Unnithan, Assistant Professor, Department of Neurosurgery, Azeezia Medical College Hospital, Meeyannoor P.O., Kollam 691537, Kerala, India. drajayakumara@gmail.com
Received: June 5, 2025 Revised: June 28, 2025 Accepted: September 22, 2025 Published online: March 20, 2026 Processing time: 251 Days and 3.8 Hours
Abstract
Hypoxic-ischemic brain injury (HIBI) can occur after cardiac arrest, asphyxiation, carbon monoxide poisoning, and diffuse brain injury. While it is a major cause of mortality and morbidity, there is no consensus on its management. Therefore, I performed a literature review to analyze HIBI pathophysiology, clinical progression, imaging, treatment, and prognosis with a goal to deepen our understanding of best treatment and prognostication options. A search was performed in PubMed, Scopus, Google scholar, EMBASE, and Crossref. The pathophysiology of HIBI consists of the primary insult due to cessation of cerebral oxygen delivery and a secondary hit due to reperfusion injury. The poor clinical prognostic factors are: Absent or extensor motor response, bilaterally absent pupillary light reflex, bilaterally absent corneal reflex, and early status myoclonus. Electroencephalogram can aid in prognostication, while magnetic resonance imaging may reveal restricted diffusion. Treatment guidelines for HIBI have been debated, particularly regarding hyperoxia vs normoxia, hypocapnia vs normocapnia, high-normal mean arterial pressure (MAP) vs low-normal MAP, and hypothermia vs normothermia. Core treatment principles include maintaining normoxia and normocapnia through ventilation, targeting a MAP of 65 mmHg, preventing fever, managing seizures, and providing neurorehabilitation.
Core Tip: The indicators of good prognosis in hypoxic-ischemic brain injury (HIBI) are: early return of continuous and reactive electroencephalogram, low blood levels of neuron-specific enolase, absence of diffusion changes in brain magnetic resonance imaging, good functional status, and Coma Remission Scale score ≥ 8. Treatment consists of maintaining systemic perfusion, treating the underlying cause of the hypoxia, and preventing ongoing brain injury. HIBI is a major cause of mortality, and the outcome after survival may vary from persistent vegetative state to neuropsychiatric disabilities.
