Abstract
The prognosis for postcardiac arrest patients remains very bleak, not only because of anoxic-ischemic neurological damage, but also because of the "postcardiac arrest syndrome," a phenomenon often severe enough to cause death before any neurological evaluation. This syndrome includes all clinical and biological manifestations related to the phenomenon of global ischemia-reperfusion triggered by cardiac arrest and return of spontaneous circulation. The main component of the postcardiac arrest syndrome is an early but severe cardiocirculatory dysfunction that may lead to multiple organ failure and death.Cardiovascular support relies on conventional medical and mechanical treatment of circulatory failure. Hemodynamic stabilization is a major objective to limit secondary brain insult. When the cause of cardiac arrest is related to myocardial infarction, percutaneous coronary revascularization is associated with improved prognosis; early angiographic exploration should then be discussed when there is no obvious extracardiac cause. Therapeutic hypothermia is now the cornerstone of postanoxic cerebral protection. Its widespread use is clearly recommended, with a favorable risk-benefit ratio in selected population. Neuroprotection also is based on the prevention of secondary cerebral damages, pending the results of ongoing therapeutic evaluations regarding the potential efficiency of new therapeutic drugs.
Highlights
Sudden death remains a major public health issue, despite improvements in prehospital management and standardization of advanced life support through wide diffusion of international guidelines [1]. Both incidence and poor prognosis are striking: according to official statistics, approximately 100,000 people are supported for out-of-hospital cardiac arrest (OHCA) in the United States each year
Less than 10% of patients admitted to the hospital after successfully resuscitated OHCA will leave the hospital without major neurological impairments
Poor neurological prognosis because two thirds of patients who survive the early phase will subsequently develop neurofunctional sequellae, which sometimes progress toward a postanoxic vegetative state and delayed death [3]
Summary
Sudden death remains a major public health issue, despite improvements in prehospital management and standardization of advanced life support through wide diffusion of international guidelines [1]. Despite the fast improvement of contractile function in survivors, this study showed that vasopressors often had to be maintained until the 72th hour, in association with important fluid infusion to maintain adequate filling pressures These data support the existence of an early and intense myocardial failure, usually regressive within 48 hours, secondarily associated with a severe vasodilatation, as a result of the generalized inflammatory syndrome, itself well documented after CA [6]. Therapeutic aspects The therapeutic management of the postcardiac arrest syndrome has two main goals: the initial treatment of shock and organ failures, and the optimization of cerebral protection These two aspects are obviously very intricate, initial treatment having the essential interest to allow bringing the majority of patients to neurological evaluation, under hemodynamic stability conditions.
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