- Post-resuscitation death contributes significantly to overall OHCA mortality
- Most patients who achieve ROSC, die after 24-72 hours of the post-resuscitation syndrome
- Post-resuscitation syndrome is characterized by
- cardiovascular dysfunction
- multi-organ failure
- failure of CNS recovery
- has similarity with sepsis syndrome
- compared to focal ischemia of stroke or MI, reperfusion following cardiac arrest resuscitation cannot be considered definitive therapy
- The post-resuscitation phase is an important therapeutic window for improving outcomes
- interruption of death pathways and end-organ ischemic injury
- for example, target temperature management significantly improves outcomes and is one of the only effective post-resuscitation intervention
- Three phase time-sensitive model by Weisfeldt and Becker
- Electrical phase
- from onset to ~ 4 minutes
- defibrillation is the ideal treatment
- Circulatory phase
- from ~ 4 to ~ 10 minutes
- requires high-quality CPR prior defibrillation
- Metabolic phase
- after ~ 10 minutes of ischemia
- requires therapies for modulation of oxidants, immune system mediators, microvascular injury, apoptosis, energy substrate depletion
- Electrical phase
References
Weisfeldt, M.L. & Becker, L.B. Resuscitation after cardiac arrest: a 3-phase time-sensitive model.[comment]. J. Am. Med. Assoc. 2002; 288(23): 3035–3038.
Adrie, C., Adib-Conquy, M. Laurent, I. et al. Successful cardiopulmonary resuscitation after cardiac arrest as a “sepsislike” syndrome. Circulation 2002; 106(5): 562–568.
Adrie, C., Laurent, I. Monchi, M. Cariou, A. Dhainaou, J.F., & Spaulding, C. Postresuscitation disease after cardiac arrest: a sepsis-like syndrome? Curr. Opin. Crit. Care 2004; 10(3): 208–212.