Anoxic brain injury pathophysiology
Pathophysiology
The underlying mechanism of post cardiac arrest syndrome is a combination of: [1] [2] [3] [4] [5] [6] [7] [8] [9] [10] [11]
Systemic Response to Ischemia and Reperfusion
- Circulatory collapse
- Hyperglycemia
- Hypotension
- Infections
- Multiorgan failure
- Ongoing tissue hypoxia / ischemia
- Fever
Myocardial Dysfunction
- Circulatory collapse
- Dysrhythmias
- Hypotension
- Reduced cardiac output
- Brain death
- Cognitive dysfunction
- Coma
- Cortical stroke
- Myoclonus
- Persistent vegetative state
- Secondary parkinsonism
- Seizures
- Spinal stroke
Effects of Persistent Precipitating Pathologies
- Cardiovascular disease (Acute coronary syndromes, cardiomyopathy)
- Chronic obstructive pulmonary disease
- Central nervous system diseases (e.g. cerebrovascular accident)
- Thromboembolic disorders (e.g. pulmonary emboli)
- Drug / substance overdose, poisoning
- Infections (sepsis, pneumonia)
- Volume loss (Hypovolemia: e.g. hemorrhage, dehydration)
- ↑ Zeiner A, Holzer M, Sterz F, et al. Hyperthermia after cardiac arrest is associated with an unfavorable neurologic outcome. Arch Intern Med. Sep 10 2001; 161(16): 2007-2012.
- ↑ van den Berghe G, Wouters P, Weekers F, et al. Intensive insulin therapy in the critically ill patients. New England Journal of Medicine. Nov 8 2001;345(19): 1359-1367.
- ↑ Van den Berghe G, Wouters PJ, Bouillon R, et al. Outcome benefit of intensive insulin therapy in the critically ill: Insulin dose versus glycemic control. Crit Care Med. Feb 2003;31(2):359-366.
- ↑ Annane D, Sebille V, Charpentier C, et al. Effect of treatment with low doses of hydrocortisone and fludrocortisone on mortality in patients with septic shock. JAMA. 2002;288(7):862-871.
- ↑ Zandbergen EG, de Haan RJ, Stoutenbeek CP, et al. Systematic review of early prediction of poor outcome in anoxic-ischaemic coma. Lancet. Dec 5 1998; 352(9143): 1808-1812.
- ↑ Rello J. Risk factors for developing pneumonia within 48 hours of intubation. Am J Respir Crit Care Med. 1999;159:1742-1746.
- ↑ Spaulding CM, Joly LM, Rosenberg A, et al. Immediate coronary angiography in survivors of out-of-hospital cardiac arrest. New England Journal of Medicine. Jun 5 1997;336(23):1629-1633.
- ↑ Adrie C, Laurent I, Monchi M, et al. Postresuscitation disease after cardiac arrest: a sepsis-like syndrome? Curr Opin Crit Care. Jun 2004;10(3):208-212.
- ↑ Rivers E, Nguyen B, Havstad S, et al. Early goal-directed therapy in the treatment of severe sepsis and septic shock. New England Journal of Medicine. 2001;345(19):1368-1377.
- ↑ Bernard SA, Gray TW, Buist MD, et al. Treatment of comatose survivors of out-of hospital cardiac arrest with induced hypothermia. New England Journal of Medicine. Feb 21 2002;346(8):557-563.
- ↑ Hypothermia after Cardiac Arrest Study G. Mild therapeutic hypothermia to improve the neurologic outcome after cardiac arrest. Erratum appears in N Engl J Med 2002 May 30;346(22):1756]. New England Journal of Medicine. Feb 21 2002;346(8):549-556.