Prevention and therapy of postresuscitation myocardial dysfunction

Raul J. Gazmuri, Max Harry Weil, Karl B. Kern, Wanchun Tang, Iyad M. Ayoub, Julieta Kolarova, Jeejabai Radhakrishnan

Research output: Chapter in Book/Report/Conference proceedingChapter

1 Scopus citations

Abstract

Introduction: It is estimated that between 400 000 and 460 000 individuals suffer an episode of sudden cardiac arrest every year in the United States. Yet, the percentage of individuals who are successfully resuscitated and leave the hospital alive with intact neurological function averages less than 10% nationwide. Efforts to restore life successfully are formidably challenging. They require not only that cardiac activity be initially restored but that injury to vital organs be prevented or minimized. A closer examination of resuscitation statistics reveals that efficient Emergency Medical Services systems are able to re-establish cardiac activity in 30% to 40% of sudden cardiac arrest victims at the scene. Yet, close to 40% die before admission to a hospital presumably from recurrent cardiac arrest or complications during transport. Of those admitted to the hospital nearly 60% succumb before discharge, such that only one in four initially resuscitated victims leaves the hospital alive. Although the causes of postresuscitation deaths have not been systematically investigated, the available information suggests that postresuscitation myocardial dysfunction, hypoxic brain damage, systemic inflammatory responses, intercurrent illnesses, or a combination thereof are the main culprits. The core pathogenic process driving such poor outcome is the intense ischemia of variable duration that organs suffer after cessation of blood flow and the subsequent reperfusion injury that accompanies the resuscitation effort. In addition, the precipitating event of cardiac arrest may also play a role in the postresuscitation phase.

Original languageEnglish (US)
Title of host publicationCardiac Arrest
Subtitle of host publicationThe Science and Practice of Resuscitation Medicine
PublisherCambridge University Press
Pages829-847
Number of pages19
ISBN (Electronic)9780511544828
ISBN (Print)05218470041, 9780521847001
DOIs
StatePublished - Jan 1 2007

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ASJC Scopus subject areas

  • Medicine(all)

Cite this

Gazmuri, R. J., Harry Weil, M., Kern, K. B., Tang, W., Ayoub, I. M., Kolarova, J., & Radhakrishnan, J. (2007). Prevention and therapy of postresuscitation myocardial dysfunction. In Cardiac Arrest: The Science and Practice of Resuscitation Medicine (pp. 829-847). Cambridge University Press. https://doi.org/10.1017/CBO9780511544828.050