الفهرس 
Pathophysiology of Post-Card
Therapeutic ModalitiesOnly 14 pages are availabe for public view
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Abstract
Return of spontaneous circulation is just the first stage in continuum of resuscitation and the quality of post cardiac arrest care will influence significantly the patient’s final outcome.
The brain, though representing 2% of total body weight, it receives 20% of cardiac output.
The normal cerebral blood flow is in the range of 45-50ml/min/100gm between a mean arterial pressure of 60 and 130 mmHg. When CBF falls below 20 to 30 ml/min/gm, marked disturbances in brain metabolism begin to occur, such as water and electrolytes shifts.
Autoregulation of CBF is responsible for keeping CBF constant despite the changes in blood pressure.
Early recognition and good management of cardiac arrest do affect outcome. 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 arrythmias. The present advanced cardiac life support protocol is based on the chain of survival.
Cardiac arrest leads to cerebral hypoxia which leads to cellular damage due to anaerobic metabolism,influx of calcium, mitochondrial dysfunction and free radical generation.
The true goal of resuscitation is the restoration of human mentation. The time after cardiac arrest is a vulnerable period that require meticulous care.
There are clinical practice guidelines for management during cardiac resuscitation, but little has been written about post resuscitation management.
To date, induced hypothermia is considered the corner stone in cerebral protection as evidenced by clinical trials. Not all patients suitable for induced hypothermia but there are criteria for induction of hypothermia.
Additional goals include keeping mean arterial blood pressure from 80 to 100 mmHg, blood glucose from 80-110 mg/dl, and PaO2 >100 mmHg for the first 24 hours.
Many drugs can be used as mannitol, adrenaline, erythropoietin, drugs decreasing free radical generation, NMDA antagonists, and nitric oxide.
Adequate monitoring is essential. Also investigations which are laboratory and neurodiagnostics are essential.
Neurological prognosis after cardiac arrest affected by many factors such as patient dependent factors as medical condition of the patient and presenting cardiac rhythm. And resuscitation dependent factors as witnessed versus unwitnessed arrest and early defibrillation.
Diagnosis of brain death is mainly clinical and it’s three essential criteria are:
Coma, absence of brainstem reflexes, and apnea.