Neurological Outcome Predictions After Application of Advanced Cardiopulmonary Resuscitation

Abstract

It is important to understand the physiology of cerebral blood flow. In order to perform proper management of patients with pathological states like during cerebral ischemia. There are several mechanisms that regulate cerebral blood flow which include chemical regulation myogenic regulation (auto regulation) neurogenic regulation and other factors like blood viscosity, vasoactive agents and age. Advanced cardiac life support protocols combine pharmacological and mechanical interventions for restoration of spontaneous circulation by improving perfusion pressures and blood flow to vital organs and treating arrhythmias. The present advanced cardiac life support protocol is based on proper opening of the air way assessment of breathing and lung ventilation checking the pulse and providing chest compression drug therapy with agents that optimize cardiac output and treat arrthymias. Recognition of arrthymias by ECG especially ventricular fibrillation and ventricular tachycardia and finally electrical defibrillation to terminate the rhythm disturbance. The success of cardiopulmonary resuscitation is determined by final neurological outcome of the individual  115 | patient. The severity of brain dysfunction caused by cardiac arrest ranges from mild to moderate cerebral disability to a vegetative state or brain death. The possibility of irreversible sever hypoxic brain damage must be taken into account with regard to post resuscitation treatment. At present such outcome predictions are based on several factors including whether the arrest occurred in-hospital or out-of hospital the efficiency of by stander cardiopulmonary resuscitation clinical history physical examination electrophysiological findings (i.e. sensory evoked potential) neuroimaging tests (CT - MRI) and levels of biochemical makers in the serum and cerebrospinal fluid (CSF) as creatine kinase (CK-BB) lactate Neuron –specific Enolase (NSE) and S-100 protein. However considerable uncertainly remains. Because there are several disorders mimic brain death and can lead to erroneous diagnosis it is crucial to know the criteria and tests for determining brain death. Maintenance of normal to high cerebral perfusion pressure normoxia and surgical decompression are by far the most important and effective neuroprotective interventions. Besides these treatment modalities concepts of physical (hyperventilation and hypothermia) and pharmacological brain protection include interventions to increase cerebral blood flow (CBF) in the ischemic  116 | territory reduction of cerebral metabolism and intracranial pressure (ICP) inhibition of lactic acid accumulation and excitatory neurotransmitter activity prevention of Ca+2 influx inhibition of lipid per oxidation and free radical scavenging.