Cardiac arrest: neurologic causes and complications

Tarakad S Ramachandran MD (Dr. Ramachandran of SUNY Upstate Medical University has no relevant financial relationships to disclose.)
Matthew Lorincz MD PhD, editor. (Dr. Lorincz of the University of Michigan receives salary support from Wilson Therapeutics AB for performing UWDRS examinations in a clinical trial.)
Originally released February 12, 1995; last updated July 9, 2014; expires July 9, 2017

Overview

In this article, the author discusses the neurologic sequelae of cardiac arrest. This syndrome, called “post-cardiac arrest syndrome,” comprises anoxic brain injury, post-cardiac arrest myocardial dysfunction, systemic ischemia/reperfusion response, and persistent precipitating pathology. Treatment is optimized with the development of regional systems of care, including goal-directed treatment modalities, therapeutic hypothermia, early coronary angiography, and temporary circulatory support when appropriate, together with comprehensive neurologic assessment and therapy.

Key points

 

• Cardiac arrest is the primary cause of death in industrialized nations. Brain injury continues to be a leading cause of mortality and morbidity in patients resuscitated after cardiac arrest.

 

• Though successful resuscitation rate ranges around 40%, good neurologic outcome after cardiac arrest is hard to achieve.

 

• Cardiac arrest survival depends on numerous strategies, and treatment of "postresuscitation disease" requires multidisciplinary implementation of timely reperfusion, proper inotropic support and monitoring, glucose control, therapeutic hypothermia, and adequate sedation in the intensive care unit, in place of therapeutic nihilism.

 

• Neurologic evaluation relies on a combination of clinical, laboratory, and instrumental parameters.

 

• Though no single method holds a specificity of 100%, simple bedside neurologic examination still strongly predicts death or poor outcome.

Historical note and terminology

One of the most significant achievements in physiology during the 17th century was William Harvey's documentation that blood within the human body was under continuous circulation. Yet, initial credit for the recognition of the ultimate dependence of the vital organs on the circulatory system should be given to Galen in the 2nd century AD. The doctrines of Galenic physiology stated that blood was produced in the liver, flowed to the heart to obtain "vital spirits," and subsequently bathed the brain to gain "animal spirits."

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