الفهرس 
Ethical issues regarding resuscitationOnly 14 pages are availabe for public view
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Abstract
There are clinical practice guidelines for management during cardiac resuscitation, but little has been written about post-resuscitation management.
The normal cerebral blood flow (CBF) is typically in the range of 45-50 ml/min/100g between a mean arterial pressure (MAP) of 60 and 130 mmHg. When CBF falls below 20 to 30 ml/min/100g, marked disturbances in brain metabolism begin to occur, such as water and electrolyte shifts and regional areas of the cerebral cortex experience failed perfusion. At blood flow rates below 10 ml/min/100g, sudden depolarization of the neurons occurs with rapid loss of intracellular potassium to the extracellular space.
Early observations on the mechanisms of ischemic injury is focused on relatively simple biochemical and physiological changes, which known to result from interruption of circulation. Examples of these changes are loss of high-energy compounds, acidosis due to anaerobic generation of lactate, and no reflow due to swelling of astrocytes with compression of brain capillaries.
Advanced cardiac life support protocols combine pharmacological and mechanical interventions for restoration of spontaneous circulation (ROSC) by improving perfusion pressures and blood flow to vital organs and treating arrhythmias. The present advanced cardiac life support protocol is based on four components: Early defibrillation, Administration of drugs, Ventilation (oxygenation), and Circulatory support.
The time after cardiac arrest is a vulnerable period that require meticulous care.
Specific goals of treatment were proposed for general care, neurologic care, respiratory care, cardiac care, and gastrointestinal care.
There was an adequate evidence to recommend therapeutic hypothermia for comatose patients who had witnessed ventricular fibrillation or ventricular tachycardia arrests. Therapeutic hypothermia could be extended to other presenting rhythms in selected circumstances.
Additional goals included mean arterial pressure 80 to 100 mmHg, glucose 5 to 8 m mol L–1 using insulin infusions, and PaO2 > 100 mmHg for the first 24 hr. Absent withdrawal to pain reflex 72 hr after resuscitation should prompt consideration of palliative care. The level of evidence for other recommendations was low.
Key for making clinical decision is information on prognosis. In patients with poor prognosis, the decision may range from the initiation of potentially aggressive measures aimed at brain resuscitation up to limitation in the intensity of medical support. And the outcomes to be predicted including death, awakening, and independence.
As regard beginning and ending resuscitation attempts, differences in ethical and cultural norms must be consid¬ered. Although the broad principles of beneficence, nonmaleficence, autonomy, and justice appear to be accepted across cultures, the priority of these principles may vary among different cultures
Finally, the proposed management strategy represents an approach to manage patients in the ICU following resuscitation from cardiac arrest. Most of the recommendations are based on low grade evidence. Additional research is needed to improve the evidence base. The presence of standard post-arrest management strategy could help and facilitate future research.