Sakurai Atsushi
Division of Emergency and Critical Care Medicine, Department of Acute Medicine, Nihon University School of Medicine.
No Shinkei Geka. 2023 Nov;51(6):1079-1088. doi: 10.11477/mf.1436204854.
Four conditions occur after cardiac arrest resuscitation and are referred to as the post-cardiac arrest syndrome. Moreover, post-cardiac arrest brain injury has the greatest impact on outcomes. Brain injury can be primary as a result of global cerebral ischemia during cardiac arrest. It may be secondary(reperfusion injury)after initiation of cardiopulmonary resuscitation. After cardiac arrest resuscitation, the patient must be managed in the intensive care unit, and it is recommended to avoid hypotension(MAP<65 mmHg), hypoxemia, and hyperoxemia. Oxygen saturation should be maintained at 94%-98%, normal ventilation(35 mmHg-45 mmHg), and body temperature below 37.5℃ for 72 h after resuscitation. The administration of anticonvulsants for abnormal electroencephalograms did not significantly affect the outcome. Prognosis should be predicted within 24 h to 72 h combining physical examination, biomarkers, electrophysiology, and imaging being predictive of poor outcomes.
心脏骤停复苏后会出现四种情况，统称为心脏骤停后综合征。此外，心脏骤停后脑损伤对预后的影响最大。脑损伤可能是心脏骤停期间全脑缺血导致的原发性损伤。也可能是心肺复苏开始后的继发性损伤（再灌注损伤）。心脏骤停复苏后，患者必须在重症监护病房进行管理，建议避免低血压（平均动脉压<65 mmHg）、低氧血症和高氧血症。复苏后72小时内，氧饱和度应维持在94%-98%，通气正常（35 mmHg-45 mmHg），体温低于37.5℃。针对脑电图异常给予抗惊厥药物治疗对预后无显著影响。应在24小时至72小时内结合体格检查、生物标志物、电生理学和影像学检查来预测预后，这些检查可提示预后不良。
