Patil Kaustubha D, Halperin Henry R, Becker Lance B
From the Department of Medicine, Division of Cardiology, Johns Hopkins University, Baltimore, MD (K.D.P., H.R.H.); Departments of Radiology and Biomedical Engineering, Johns Hopkins University, Baltimore, MD (H.R.H.); and Department of Emergency Medicine, University of Pennsylvania, Philadelphia (L.B.B.).
Circ Res. 2015 Jun 5;116(12):2041-9. doi: 10.1161/CIRCRESAHA.116.304495.
The modern treatment of cardiac arrest is an increasingly complex medical procedure with a rapidly changing array of therapeutic approaches designed to restore life to victims of sudden death. The 2 primary goals of providing artificial circulation and defibrillation to halt ventricular fibrillation remain of paramount importance for saving lives. They have undergone significant improvements in technology and dissemination into the community subsequent to their establishment 60 years ago. The evolution of artificial circulation includes efforts to optimize manual cardiopulmonary resuscitation, external mechanical cardiopulmonary resuscitation devices designed to augment circulation, and may soon advance further into the rapid deployment of specially designed internal emergency cardiopulmonary bypass devices. The development of defibrillation technologies has progressed from bulky internal defibrillators paddles applied directly to the heart, to manually controlled external defibrillators, to automatic external defibrillators that can now be obtained over-the-counter for widespread use in the community or home. But the modern treatment of cardiac arrest now involves more than merely providing circulation and defibrillation. As suggested by a 3-phase model of treatment, newer approaches targeting patients who have had a more prolonged cardiac arrest include treatment of the metabolic phase of cardiac arrest with therapeutic hypothermia, agents to treat or prevent reperfusion injury, new strategies specifically focused on pulseless electric activity, which is the presenting rhythm in at least one third of cardiac arrests, and aggressive post resuscitation care. There are discoveries at the cellular and molecular level about ischemia and reperfusion pathobiology that may be translated into future new therapies. On the near horizon is the combination of advanced cardiopulmonary bypass plus a cocktail of multiple agents targeted at restoration of normal metabolism and prevention of reperfusion injury, as this holds the promise of restoring life to many patients for whom our current therapies fail.
心脏骤停的现代治疗是一个日益复杂的医疗程序，其治疗方法不断快速变化，旨在挽救猝死患者的生命。提供人工循环和除颤以终止心室颤动这两个主要目标对于挽救生命仍然至关重要。自60年前确立以来，它们在技术方面有了显著改进，并在社区得到了更广泛的应用。人工循环的发展包括努力优化徒手心肺复苏、旨在增强循环的外部机械心肺复苏设备，并且可能很快会进一步发展到快速部署专门设计的内部紧急体外循环设备。除颤技术的发展已从直接应用于心脏的笨重内部除颤器电极板，发展到手动控制的外部除颤器，再到现在可以在柜台购买以供社区或家庭广泛使用的自动体外除颤器。但心脏骤停的现代治疗现在不仅仅涉及提供循环和除颤。正如一个三相治疗模型所表明的，针对心脏骤停时间较长的患者的新方法包括用治疗性低温治疗心脏骤停的代谢阶段、治疗或预防再灌注损伤的药物、专门针对无脉电活动的新策略（无脉电活动是至少三分之一心脏骤停患者的初始心律）以及积极的复苏后护理。在细胞和分子水平上有关于缺血和再灌注病理生物学的发现，这些发现可能会转化为未来的新疗法。在不久的将来，先进的体外循环与多种旨在恢复正常代谢和预防再灌注损伤的药物的联合应用有望为许多目前治疗方法无效的患者恢复生命。
