Division of Cardiology, University of Toronto/University Health Network, Toronto, Ontario, Canada.
Department of Emergency Medicine, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada.
Can J Cardiol. 2018 Feb;34(2):156-167. doi: 10.1016/j.cjca.2017.11.013.
Survival with a good quality of life after cardiac arrest continues to be abysmal. Coordinated resuscitative care does not end with the effective return of spontaneous circulation (ROSC)-in fact, quite the contrary is true. Along with identifying and appropriately treating the precipitating cause, various components of the post-cardiac arrest syndrome also require diligent observation and management, including post-cardiac arrest neurologic injury and myocardial dysfunction, systemic ischemia-reperfusion phenomenon with potential consequent multiorgan failure, and the various sequelae of critical illness. There is growing evidence that an early invasive approach to coronary reperfusion with percutaneous coronary intervention, together with active targeted temperature management and optimization of hemodynamic, ventilator, and metabolic parameters, may improve survival and neurologic outcomes in cardiac arrest survivors. Neuroprognostication is complex, as are survivorship issues and long-term rehabilitation. Our paramedics, emergency physicians, and resuscitation specialists are all to be congratulated for ever-increasing success with ROSC… but now the real work begins.
心搏骤停后生存并保持良好的生活质量仍然很差。协调复苏治疗并没有随着自主循环（ROSC）的有效恢复而结束——实际上，情况恰恰相反。除了识别和适当治疗引发心搏骤停的原因外，心搏骤停后综合征的各个组成部分也需要仔细观察和管理，包括心搏骤停后的神经损伤和心肌功能障碍、潜在多器官衰竭的全身缺血再灌注现象，以及危重病的各种后遗症。越来越多的证据表明，早期采用经皮冠状动脉介入治疗进行冠状动脉再灌注，以及积极的靶向体温管理和优化血流动力学、呼吸机和代谢参数，可能会改善心搏骤停幸存者的生存和神经结局。神经预后很复杂，生存问题和长期康复也是如此。我们的护理人员、急诊医生和复苏专家都应该为 ROSC 的不断成功而祝贺……但现在真正的工作才刚刚开始。
