Chen Wei-Ting, Tsai Min-Shan, Huang Chien-Hua, Chang Wei-Tien, Chen Wen-Jone
Department of Emergency Medicine.
Department of Internal Medicine (Cardiology division), National Taiwan University Medical College and Hospital, Taipei, Taiwan.
Acta Cardiol Sin. 2022 May;38(3):391-399. doi: 10.6515/ACS.202205_38(3).20211220A.
Improvements in teamwork and resuscitation science have considerably increased the success rate of cardiopulmonary resuscitation. Cerebral injury, myocardial dysfunction, systemic ischemia and reperfusion response, and precipitating pathology after the return of spontaneous circulation (ROSC) constitute post-cardiac arrest syndrome. Because the entire body is involved in cardiac arrest and the early post-arrest period, protocolized post-arrest care consisting of cardiovascular optimization, ventilation and oxygenation adjustment, coronary revascularization, targeted temperature management (TTM), and control of seizures and blood sugar would benefit survival and neurological outcomes. Emergent coronary angiography is suggested for cardiac arrest survivors suspected of having ST-elevation myocardial infarction, however the superiority of culprit or complete revascularization in patients with multivessel coronary lesions remains undetermined. High-quality TTM should be considered for comatose patients who are successfully resuscitated from cardiac arrest, however the optimal target temperature may depend on the severity of their condition. The optimal timing for making prognostication should be no earlier than 72 h after rewarming in TTM patients, and 72 h following ROSC in non-TTM patients. To predict neurological recovery correctly may need the use of several prognostic tools together, including clinical neurological examinations, brain images, neurological studies and biomarkers.
团队协作和复苏科学的进步显著提高了心肺复苏的成功率。脑损伤、心肌功能障碍、全身缺血及再灌注反应，以及自主循环恢复（ROSC）后的诱发病理状况构成了心脏骤停后综合征。由于心脏骤停及骤停后早期整个身体都受到影响，因此，由心血管优化、通气和氧合调整、冠状动脉血运重建、目标温度管理（TTM）以及癫痫和血糖控制组成的标准化骤停后护理将有利于患者存活及神经功能转归。对于疑似发生ST段抬高型心肌梗死的心脏骤停幸存者，建议进行急诊冠状动脉造影，然而，多支冠状动脉病变患者罪犯血管血运重建或完全血运重建的优势仍未确定。对于从心脏骤停中成功复苏的昏迷患者，应考虑进行高质量的TTM，然而，最佳目标温度可能取决于其病情严重程度。进行预后评估的最佳时机在接受TTM治疗的患者中应不早于复温后72小时，在未接受TTM治疗的患者中应在ROSC后72小时。要正确预测神经功能恢复可能需要联合使用多种预后评估工具，包括临床神经学检查、脑部影像、神经学检查及生物标志物。
