1. Cerebral resuscitation
1. post-resuscitation state
2. post-resuscitation care
3. prognostic factor

2. 1. Post-resuscitation state
Ischemic injury
Reperfusion injury

3. After cardiac arrest O2 Glucose, glycogen ATP고갈 : 10sec : 2-4min

4. 4 phases of post-resuscitation

5. 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

6. 1-3days
Intestinal permeability 증가
Sepsis syndrome
MODS

7. Days
Serious infection !!

9. 2. Post-resuscitation care
1) General support
2) Hypothermia

10. the precipitating cause
Consider
the precipitating cause
of the arrest!!!!

11. General support - principle
1. Hemodynamic stability
MAP>60mmHg
2. Adequate oxygenation
PaO mmHg
PCO mmHg
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

12. General support - blood sugar
Controversial
Cerebral swelling, hyperglycemia, hyperinsulinemia
Decreased CBF and worse outcome

13. Failed to show efficacy
1. ICP감소시키는 manage
Routine hyperventilation
Mannitolization
2. Hyperoxia
3. Induced hypertension
4. pentobarbital coma
5. Ca antagonist
6. Glucocorticoid

14. Hypothermia Mild hypothermia spontaneously Hypothermia
Should not be actively warmed
(classIIb)
Hypothermia
Should not be induced actively
(class indeterminate)
In ACLS

15. Michael Holzer, M.D.

16. Stephan A. Bernard,M.D.

18. 3. Prognostic factor