Ischemia/Reperfusion during Cardiac Arrest

  • 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

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.

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