Yao Zhun, Zhao Yuanrui, Lu Liping, Li Yinping, Yu Zhui
Department of Critical Care Medicine, Renmin Hospital of Wuhan University, Wuhan 430060, China.
Department of Pathophysiology, Hubei Province Key Laboratory of Allergy and Immunology, Taikang Medical School (School of Basic Medical Sciences), Wuhan University, Wuhan 430060, China.
Resusc Plus. 2024 Jul 19;19:100719. doi: 10.1016/j.resplu.2024.100719. eCollection 2024 Sep.
Cardiac arrest and successful resuscitation cause whole-body ischemia and reperfusion, leading to brain injury and extracerebral multiple organ dysfunction. Brain injury is the leading cause of death and long-term disability in resuscitated survivors, and was conceptualized and treated as an isolated injury, which has neglected the brain-visceral organ crosstalk. Extracerebral organ dysfunction is common and is significantly associated with mortality and poor neurological prognosis after resuscitation. However, detailed description of the characteristics of post-resuscitation multiple organ dysfunction is lacking, and the bidirectional interactions between brain and visceral organs need to be elucidated to explore new treatment for neuroprotection. This review aims to describe current concepts of post-cardiac arrest brain injury and specific characteristics of post-resuscitation dysfunction in cardiovascular, respiratory, renal, hepatic, adrenal, gastrointestinal, and neurohumoral systems. Additionally, we discuss the crosstalk between brain and extracerebral organs, especially focusing on how visceral organ dysfunction and other factors affect brain injury progression. We think that clarifying these interactions is of profound significance on how we treat patients for neural/systemic protection to improve outcome.
心脏骤停和成功复苏会导致全身缺血和再灌注，进而引发脑损伤和脑外多器官功能障碍。脑损伤是复苏后存活者死亡和长期残疾的主要原因，过去一直被视为一种孤立的损伤，而忽略了脑与内脏器官之间的相互作用。脑外器官功能障碍很常见，并且与复苏后的死亡率及不良神经预后显著相关。然而，目前缺乏对复苏后多器官功能障碍特征的详细描述，需要阐明脑与内脏器官之间的双向相互作用，以探索神经保护的新疗法。本综述旨在描述心脏骤停后脑损伤的当前概念，以及复苏后心血管、呼吸、肾脏、肝脏、肾上腺、胃肠道和神经体液系统功能障碍的具体特征。此外，我们还将讨论脑与脑外器官之间的相互作用，尤其关注内脏器官功能障碍和其他因素如何影响脑损伤的进展。我们认为，阐明这些相互作用对于我们如何治疗患者以实现神经/全身保护从而改善预后具有深远意义。
