The dynamic pathophysiology of post cardiac arrest brain injury: “time is brain” DOI

C. Allen,

Jordan Bird, Mypinder S. Sekhon

et al.

Current Opinion in Critical Care, Journal Year: 2025, Volume and Issue: unknown

Published: Feb. 28, 2025

To review the time dependent nature of postcardiac arrest brain injury (PCABI) while contextualizing clinical trial evidence. PCABI represents a dynamic entity with respect to its pathophysiology. Intuitively, pathophysiology has been characterized focusing on mechanisms associated cerebral ischemia. Interventions that augment oxygen delivery, such as increasing mean arterial pressure, have garnered interest. Regrettably, these trials not demonstrated improved outcomes. At core this conundrum is employing interventions approximately 4-6 h after return spontaneous circulation (ROSC). This therapeutic window likely far past efficacy period resumption delivery ischemic brain. Thus, we suggest compartmentalizing into four phases: circulatory arrest; intra-arrest physiology; immediate reperfusion; and delayed reperfusion. Culprit are discussed for each phase contextualization recent results. restoration in manner from ROSC diminished efficacy. must be viewed aimed at restoring only efficacious if applied immediately ROSC.

Language: Английский

The dynamic pathophysiology of post cardiac arrest brain injury: “time is brain” DOI

C. Allen,

Jordan Bird, Mypinder S. Sekhon

et al.

Current Opinion in Critical Care, Journal Year: 2025, Volume and Issue: unknown

Published: Feb. 28, 2025

To review the time dependent nature of postcardiac arrest brain injury (PCABI) while contextualizing clinical trial evidence. PCABI represents a dynamic entity with respect to its pathophysiology. Intuitively, pathophysiology has been characterized focusing on mechanisms associated cerebral ischemia. Interventions that augment oxygen delivery, such as increasing mean arterial pressure, have garnered interest. Regrettably, these trials not demonstrated improved outcomes. At core this conundrum is employing interventions approximately 4-6 h after return spontaneous circulation (ROSC). This therapeutic window likely far past efficacy period resumption delivery ischemic brain. Thus, we suggest compartmentalizing into four phases: circulatory arrest; intra-arrest physiology; immediate reperfusion; and delayed reperfusion. Culprit are discussed for each phase contextualization recent results. restoration in manner from ROSC diminished efficacy. must be viewed aimed at restoring only efficacious if applied immediately ROSC.

Language: Английский

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