Postcardiac arrest syndrome: from immediate resuscitation to long-term outcome.

Abstract : ABSTRACT: Prognosis of post-cardiac arrest patients remains very bleak, not only because of anoxic-ischemic neurological damage, but also because of the "post-cardiac arrest syndrome", a phenomenon often enough severe to cause death before any neurological evaluation. This syndrome includes all clinical and biological manifestations related to the phenomenon of global ischemia-reperfusion triggered by cardiac arrest and return of spontaneous circulation. The main component of the post-cardiac arrest syndrome is an early but severe cardio-circulatory dysfunction that may lead to multiple organ failure and death. Cardiovascular support relies on conventional medical and mechanical treatment of circulatory failure. Hemodynamic stabilization is a major objective to limit secondary brain insult. When the cause of cardiac arrest is related to myocardial infarction, percutaneous coronary revascularization is associated with improved prognosis; early angiographic exploration should then be discussed when there is no obvious extra-cardiac cause. Therapeutic hypothermia is now the cornerstone of post anoxic cerebral protection. Its widespread use is clearly recommended, with favourable risk-benefit ratio in selected population. Neuroprotection is also based on the prevention of secondary cerebral damages, pending the results of ongoing therapeutic evaluations regarding the potential efficiency of new therapeutic drugs.