Mayo Clinic School of Graduate Medical Education, Department of Internal Medicine, Mayo Clinic, Scottsdale, AZ, USA.
Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, PA, USA.
Resuscitation. 2022 Oct;179:116-123. doi: 10.1016/j.resuscitation.2022.08.013. Epub 2022 Aug 24.
Patients successfully resuscitated from cardiac arrest often have brain injury, myocardial dysfunction, and systemic ischemia-reperfusion injury, collectively termed the post-cardiac arrest syndrome (PCAS). To improve outcomes, potential therapies must be able to be administered early in the post-arrest course and provide broad cytoprotection, as ischemia-reperfusion injury affects all organ systems. Our understanding of the immune system contributions to the PCAS has expanded, with animal models detailing biologically plausible mechanisms of secondary injury, the protective effects of available immunomodulatory drugs, and how immune dysregulation underlies infection susceptibility after arrest. In this narrative review, we discuss the dysregulated immune response in PCAS, human trials of targeted immunomodulation therapies, and future directions for immunomodulation following cardiac arrest.
从心脏骤停中成功复苏的患者常常会出现脑损伤、心肌功能障碍和全身缺血再灌注损伤，这些统称为心脏骤停后综合征（PCAS）。为了改善预后，潜在的治疗方法必须能够在心脏骤停后早期进行，并提供广泛的细胞保护，因为缺血再灌注损伤会影响所有器官系统。我们对免疫系统在 PCAS 中的作用的理解已经扩大，动物模型详细说明了二次损伤的生物学上合理的机制、现有免疫调节药物的保护作用，以及免疫失调如何在心脏骤停后导致感染易感性。在这篇叙述性综述中，我们讨论了 PCAS 中失调的免疫反应、针对免疫调节治疗的人体试验，以及心脏骤停后免疫调节的未来方向。
