Marchese Giuseppe, Bungaro Elisabetta, Magliocca Aurora, Fumagalli Francesca, Merigo Giulia, Semeraro Federico, Mereto Elisa, Babini Giovanni, Roman-Pognuz Erik, Stirparo Giuseppe, Cucino Alberto, Ristagno Giuseppe
UOC Anestesia e Rianimazione, Ospedale Nuovo di Legnano, ASST Ovest Milanese, 20025 Legnano, Italy.
Department of Pathophysiology and Transplantation, University of Milan, 20122 Milan, Italy.
J Clin Med. 2024 Apr 24;13(9):2498. doi: 10.3390/jcm13092498.
Although cardiopulmonary resuscitation (CPR) includes lifesaving maneuvers, it might be associated with a wide spectrum of iatrogenic injuries. Among these, acute lung injury (ALI) is frequent and yields significant challenges to post-cardiac arrest recovery. Understanding the relationship between CPR and ALI is determinant for refining resuscitation techniques and improving patient outcomes. This review aims to analyze the existing literature on ALI following CPR, emphasizing prevalence, clinical implications, and contributing factors. The review seeks to elucidate the pathogenesis of ALI in the context of CPR, assess the efficacy of CPR techniques and ventilation strategies, and explore their impact on post-cardiac arrest outcomes. CPR-related injuries, ranging from skeletal fractures to severe internal organ damage, underscore the complexity of managing post-cardiac arrest patients. Chest compression, particularly when prolonged and vigorous, i.e., mechanical compression, appears to be a crucial factor contributing to ALI, with the concept of cardiopulmonary resuscitation-associated lung edema (CRALE) gaining prominence. Ventilation strategies during CPR and post-cardiac arrest syndrome also play pivotal roles in ALI development. The recognition of CPR-related lung injuries, especially CRALE and ALI, highlights the need for research on optimizing CPR techniques and tailoring ventilation strategies during and after resuscitation.
尽管心肺复苏（CPR）包含挽救生命的操作，但它可能会引发一系列医源性损伤。其中，急性肺损伤（ALI）较为常见，给心脏骤停后的恢复带来了重大挑战。了解心肺复苏与急性肺损伤之间的关系对于改进复苏技术和改善患者预后至关重要。本综述旨在分析现有关于心肺复苏后急性肺损伤的文献，重点关注其发生率、临床意义及相关因素。该综述试图阐明心肺复苏背景下急性肺损伤的发病机制，评估心肺复苏技术和通气策略的效果，并探讨它们对心脏骤停后预后的影响。与心肺复苏相关的损伤，从骨骼骨折到严重的内脏器官损伤，凸显了管理心脏骤停后患者的复杂性。胸部按压，尤其是长时间且用力的按压，即机械按压，似乎是导致急性肺损伤的关键因素，心肺复苏相关性肺水肿（CRALE）的概念日益受到关注。心肺复苏期间及心脏骤停后综合征的通气策略在急性肺损伤的发生发展中也起着关键作用。认识到与心肺复苏相关的肺损伤，尤其是CRALE和ALI，凸显了研究优化心肺复苏技术以及在复苏期间和之后调整通气策略的必要性。
