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Chapter-22 Prognostication after Cardiac Arrest

BOOK TITLE: Yearbook of Anesthesiology-7

Author
1. Chaudhry Suman D
2. Pandurangan Murali
ISBN
9789352702978
DOI
10.5005/jp/books/14141_23
Edition
1/e
Publishing Year
2018
Pages
15
Author Affiliations
1. Wrightington Wigan and Leigh NHS Foundation Trust and Rotherham NHS Foundation Trust, United Kingdom, London, sumchaudhry@gmail.com
2. Medcare Hospital LLC, Dubai, UAE, drmuralip@hotmail.com
Chapter keywords
Cardiopulmonary resuscitation, CPR, hypoxic-ischemic brain injury, HIBI, targeted temperature management, TTM, cardiocerebral resuscitation, CCR, systemic inflammatory response syndrome, SIRS

Abstract

High-quality cardiopulmonary resuscitation (CPR), early defibrillation, targeted temperature management (TTM) and early coronary revascularization have been in prominence of attention from the perspective of cerebral vulnerability ensuing cardiac arrest. Despite best convention and adherence to latest guidelines, many patients submit to hypoxic-ischemic brain injury (HIBI) and post cardiac arrest syndrome as primary reasons for mortality and poor long-term prognosis. Regional heterogeneity produces different brain injury phenotypes and secondary injuries described as “Two Hit” model consequent to return of spontaneous circulation (ROSC). Prohibition of secondary injury remains the most crucial determinant of ultimate outcome nevertheless it is superimposed on different patient characteristics and prevailing individual comorbidities. In depth understanding of pathophysiology of CA along with serum biomarker assays in last 2 years is a new paradigm in prognostication. This is adopted for stratification and targeted therapies for patients with HIBI.

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