PATHOPHYSIOLOGY OF ISCHEMIA AND REPERFUSION -WHAT MATTERS DURING ARREST AND CPR

摘要

The majority of cardiac arrest patients that initially achieve return of spontaneous circulation (ROSC) will not survive to hospital discharge. This makes cardiac arrest the most profound and deadly form of (global) ischemia and reperfusion, in both veterinary and human medicine. The epidemiology of the disease in humans is as follows. In the United States alone, an estimated 300'000 people experience out-of-hospital cardiac arrest. In 150'000 of these (50%), resuscitation is attempted; 40'000 of these (26.7%) achieve return of spontaneous circulation (ROSC) with admittance to ICU ensues. Of these, 13'000 patients (32.5%; 4.3% of total arrests) live to hospital discharge, and the majority of those survivors (lO'OOO, 77%) achieve good neurological outcome.1This means that between 60% and 70% of sudden cardiac arrest (SCA) victims originally resuscitated go on to die. Similarly, 70% of the people suffering from in-hospital cardiac arrest will succumb to their disease despite being initially successfully resuscitated. There is no epidemiological information available for OHCA in veterinary medicine, but likely the numbers may be even worse. For in-hospital cardiac arrest, individual veterinary centers report survival to discharge rates of 2 to 10% for dogsand cats, despite initial ROSC rates of 35 to 45%. Patients die during a lethal post-cardiac arrest syndrome that is characterized by four major components: anoxic brain injury, multiorgan failure, cardiogenic shock, and the sequela of preexisting diseases.