الفهرس 
ETIOLOGY OF CARDIAC ARRESTOnly 14 pages are availabe for public view
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Abstract
متلازمة ما بعد إنعاش القلب و الرئة
الإعتبارات الرئيسية والحديث في العلاج
Sudden death remains a major public health issue, despite improvements in pre-hospital management and standardization of advanced life support through wide diffusion of international guidelines.
Even more problematic, patients who survive the initial phase of pre-hospital care, the course usually leads to a syndrome originally described as an early reperfusion syndrome (or “postresuscitation syndrome”), which usually appears between the 4th and 24th hour in the form of stereotypical features whose extreme form involves a state of shock, high fever, and severe biological disorders.
Resumption of spontaneous circulation after prolonged complete whole-body ischemia is an unnatural pathophysiological state created by successful cardiopulmonary resuscitation (CPR).
Post-cardiac arrest syndrome is a unique and complex combination of pathophysiological processes, including (1) post-cardiac arrest brain injury, (2) post-cardiac arrest myocardial dysfunction, and (3) systemic ischemia/reperfusion response. This state is often complicated by a fourth component: the unresolved pathological process that caused the cardiac arrest.
The pathophysiology of this syndrome explains the observed features and justifies the therapeutic interventions that must be performed to achieve a favorable neurological evolution. Optimizing post-resuscitation care is of paramount importance, because it represents the last link of the survival chain.
The majority of research on cardiac arrest over the past half-century has focused on improving the rate of ROSC. However, many interventions improve ROSC without improving long-term survival. The translation of optimized basic life support (BLS) and advanced life support (ALS) interventions into the best possible outcomes is important for optimization of post-cardiac arrest care.
The primary objective of such care is to obtain survival with no or little neurological sequels. By influencing the vital and functional prognosis of patients, cerebral protection is now an essential part of the management of post cardiac-arrest patients. Currently, it relies mainly on therapeutic hypothermia.
New pharmacological and non-pharmacological treatments should contribute to further improve the prognosis of these patients. Novel pharmaceutical approaches rely on a better understanding of the pathophysiology of cardiac arrest and post-resuscitation syndrome. Some medications are targeted primarily towards enhancing the return of spontaneous circulation and increasing survival rates, while others mostly aim at the attenuation of post-arrest myocardial and neurological impairment.
The reliability of early prognostication (<72 h after arrest) remains limited, and the impact of emerging therapies (e.g., hypothermia) on accuracy of prognostication has yet to be elucidated.
The neurological exam must be accompanied by at least one other modality. EEG has a robust amount of evidence with regard to prognostication in the post cardiac arrest patient. Biomarkers such as NSE and S-100B, can also be used. Finally the possibility exists for BIS monitoring to play a role in early prognostication. Thus, there still needs to be larger, more robust studies, to validate the optimal timing and the various prognostication modalities.