Cerebral resuscitation 1. post-resuscitation state 2. post-resuscitation care 3. prognostic factor
1. Post-resuscitation state Ischemic injury Reperfusion injury
After cardiac arrest O2 Glucose, glycogen ATP고갈 : 10sec : 2-4min
4 phases of post-resuscitation
Cardiovascular dysfunction ~24hr Transient hyperemia :15-30min Delayed hypoperfusion : 90min~12hrs High cytosolic Ca++ Excitotoxic glutamate Free radical Protein production 감소 Neuronal death!! Cardiovascular dysfunction
1-3days Intestinal permeability 증가 Sepsis syndrome MODS
Days Serious infection !!
2. Post-resuscitation care 1) General support 2) Hypothermia
the precipitating cause Consider the precipitating cause of the arrest!!!!
General support - principle 1. Hemodynamic stability MAP>60mmHg 2. Adequate oxygenation PaO2 100-150mmHg PCO2 40-45mmHg Midazolam & fentanyl : facilitate ventilation 3. Prevention of secondary brain damage Head position : 30° elevation, without turning 4. myoclonus & seizure antiepileptics or NM blocker 5. GI system L-tube Enteric feeding as soon as possible
General support - blood sugar Controversial Cerebral swelling, hyperglycemia, hyperinsulinemia Decreased CBF and worse outcome
Failed to show efficacy 1. ICP감소시키는 manage Routine hyperventilation Mannitolization 2. Hyperoxia 3. Induced hypertension 4. pentobarbital coma 5. Ca antagonist 6. Glucocorticoid
Hypothermia Mild hypothermia spontaneously Hypothermia Should not be actively warmed (classIIb) Hypothermia Should not be induced actively (class indeterminate) In ACLS
Michael Holzer, M.D.
Stephan A. Bernard,M.D.
3. Prognostic factor