Zhou Yaguang, Chen Di, Ma Xiao peng, Yang Guang tian
Department of Emergency, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.
Med Hypotheses. 2009 Sep;73(3):321-3. doi: 10.1016/j.mehy.2009.03.014. Epub 2009 Apr 24.
Although current cardiopulmonary resuscitation (CPR) performance can increase the rates of restoration of spontaneous circulation (ROSC) and survival to hospital admission, the discharge rates of patients remain disappointing. The high mortality rate is attributed to post-cardiac arrest brain injury. The discovery of the postconditioning phenomenon opens a door to endogenous neuroprotection. The protection mechanisms of postconditioning include attenuating mitochondrial calcium overload and reducing oxidative stress, recruiting the reperfusion injury salvage kinase (RISK) pathway, and preventing from the mitochondrial permeability transition pore (mPTP) opening at the time of reperfusion. An advantage of postconditioning lies in the potentially clinical application in the unexpected ischemic situation. Prior laboratory researches indicate that postconditioning may lessen the reperfusion/ischemia-induced injury in unexpected coronary occlusion, acute myocardial infarction and stroke. Because cardiac arrest, stroke and acute myocardial infarction have a similar pathophysiological process, we hypothesize that postconditioning could be used in the clinical practice of CPR to treat patients with post-cardiac arrest brain injury. We propose a novel protocol of "Postconditioning cardiocerebral resuscitation (Post-CCR)". The Post-CCR includes applying three cycles of 18s chest compression and 10s interruption for ventilation first, and then executing chest compression only CPR until the patients return spontaneous circulation. Post-CCR can not only provide vital blood flow to the heart and brain but also activate endogenous protective mechanism to lessen post-cardiac arrest brain injury. We consider that it would become a feasible, safe and efficient cerebralprotective intervention in the prevention and alleviation of post-cardiac arrest brain injury, which would also improve the outcome after cardiac arrest.
尽管目前的心肺复苏（CPR）操作可提高自主循环恢复（ROSC）率和入院存活率，但患者的出院率仍不尽人意。高死亡率归因于心脏骤停后脑损伤。后适应现象的发现为内源性神经保护打开了一扇门。后适应的保护机制包括减轻线粒体钙超载和降低氧化应激、激活再灌注损伤挽救激酶（RISK）通路以及防止再灌注时线粒体通透性转换孔（mPTP）开放。后适应的一个优势在于其在意外缺血情况下具有潜在的临床应用价值。先前的实验室研究表明，后适应可能减轻意外冠状动脉闭塞、急性心肌梗死和中风时的再灌注/缺血诱导损伤。由于心脏骤停、中风和急性心肌梗死具有相似的病理生理过程，我们推测后适应可用于CPR的临床实践中，以治疗心脏骤停后脑损伤患者。我们提出了一种新颖的“后适应心肺脑复苏（Post-CCR）”方案。Post-CCR包括先进行三个周期的18秒胸外按压和10秒通气中断，然后仅进行胸外按压的CPR，直至患者恢复自主循环。Post-CCR不仅可为心脏和大脑提供重要血流，还能激活内源性保护机制以减轻心脏骤停后脑损伤。我们认为，它将成为预防和减轻心脏骤停后脑损伤的一种可行、安全且有效的脑保护干预措施，这也将改善心脏骤停后的预后。
