Post Resuscitation Syndrome Major Concerns and Advances in Management

Abstract

Sudden death remains a major public health issue, despite improvements in pre-hospital management and standardization of advanced life support through wide diffusion of international guidelines. Even more problematic, patients who survive the initial phase of pre-hospital care, the course usually leads to a syndrome originally described as an early reperfusion syndrome (or “postresuscitation syndrome”), which usually appears between the 4th and 24th hour in the form of stereotypical features whose extreme form involves a state of shock, high fever, and severe biological disorders. Resumption of spontaneous circulation after prolonged complete whole-body ischemia is an unnatural pathophysiological state created by successful cardiopulmonary resuscitation (CPR). Post-cardiac arrest syndrome is a unique and complex combination of pathophysiological processes, including (1) post-cardiac arrest brain injury, (2) post-cardiac arrest myocardial dysfunction, and (3) systemic ischemia/reperfusion response. This state is often complicated by a fourth component: the unresolved pathological process that caused the cardiac arrest.