Department of Pharmacy, NYU Langone Health, New York, New York.
Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, New York University School of Medicine, New York, New York.
Ann N Y Acad Sci. 2022 Jan;1507(1):49-59. doi: 10.1111/nyas.14613. Epub 2021 May 31.
Cardiac arrest has many implications for morbidity and mortality. Few interventions have been shown to improve return of spontaneous circulation (ROSC) and long-term outcomes after cardiac arrest. Ischemic-reperfusion injury upon achieving ROSC creates an imbalance between oxygen supply and demand. Multiple events occur in the postcardiac arrest period, including excitotoxicity, mitochondrial dysfunction, and oxidative stress and inflammation, all of which contribute to ongoing brain injury and cellular death. Given that complex pathophysiology underlies global brain hypoxic ischemia, neuroprotective strategies targeting multiple stages of the neuropathologic cascade should be considered as a means of mitigating secondary neuronal injury and improving neurologic outcomes and survival in cardiac arrest victims. In this review article, we discuss a number of different pharmacologic agents that may have a potential role in targeting these injurious pathways following cardiac arrest. Pharmacologic therapies most relevant for discussion currently include memantine, perampanel, magnesium, propofol, thiamine, methylene blue, vitamin C, vitamin E, coenzyme Q , minocycline, steroids, and aspirin.
心脏骤停对发病率和死亡率有诸多影响。目前仅有少数干预措施被证明可以提高心脏骤停后自主循环恢复（ROSC）和长期预后。ROSC 时的缺血再灌注损伤导致氧供与氧需之间失衡。心脏骤停后会发生多种事件，包括兴奋性毒性、线粒体功能障碍、氧化应激和炎症，所有这些都会导致持续的脑损伤和细胞死亡。鉴于全球脑缺氧缺血的复杂病理生理学，应考虑针对神经病理级联反应多个阶段的神经保护策略，以减轻继发性神经元损伤，改善心脏骤停患者的神经结局和存活率。在这篇综述文章中，我们讨论了一些可能在心脏骤停后针对这些损伤途径发挥作用的不同药物。目前最相关的讨论药物治疗包括美金刚、吡仑帕奈、镁、丙泊酚、硫胺素、亚甲蓝、维生素 C、维生素 E、辅酶 Q、米诺环素、类固醇和阿司匹林。
