Management and Prognosis of Post-Cardiac Arrest Syndrome

INVITED REVIEW

J Neurocrit Care 2009;2(Suppl 1): 10-15.

심정지 후 증후군: 치료와 예후

고 임 석

국립의료원 신경과학교실

Management and Prognosis of Post-Cardiac Arrest Syndrome

Im Seok Koh, MD

Department of Neurology, National Medical Center, Seoul, Korea

ABSTRACT

The pathology caused by complete ischemia and reperfusion after cardiac arrest was unique in that it had a definite cause, time course, and pathologic process, this state called a new term:”post-cardiac arrest syndrome”. Post-cardiac arrest syndrome is a complex combination of pathological processes and symptoms, which include 1) post-cardiac arrest brain injury (hypoxic-ischemic brain injury), 2) post-cardiac arrest myocardial dysfunction, 3) systemic ischemia/reperfusion response, and 4) underlying process caused the cardiac arrest. Advances in cardiopulmonary resuscitation enable progress in management of post-cardiac arrest syndrome, but the overall prognosis after cardiac arrest has not improved. The managements include the effective monitoring, early hemodynamic optimization, oxygenation, ventilation, circulatory support, acute coronary syndrome treatment, therapeutic hypothermia, proper sedation and neuromuscular blockade, seizure control and prevention, aggressive fever and glucose control, treatment of adrenal dysfunction, renal function, and infection.

Key Words: Post-cardiac arrest syndrome·Hypoxic-ischemic brain injury