Current opinion in critical care
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In settings of cardiac arrest, reestablishing vital organ perfusion plays an important role in initial CPR. As a pharmacologic intervention, vasopressor agents aim to improve aortic diastolic pressure and, consequently, coronary and cerebral perfusion pressures. ⋯ In this article, the main traditional and novel adrenergic and nonadrenergic vasopressor drugs are reviewed.
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Curr Opin Crit Care · Jun 2004
ReviewCombination of active compression decompression cardiopulmonary resuscitation and the inspiratory impedance threshold device: state of the art.
Over the past decade, the combination of active compression decompression (ACD) cardiopulmonary resuscitation (CPR) and an impedance threshold device (ITD) has been shown to significantly increase vital organ perfusion pressures and survival rates in animals and humans. The purpose of this review article is to summarize the recent advances with this new technology. ⋯ On the basis of the cumulative findings of these studies, it is concluded that ACD/ITD CPR provides superior vital organ blood flow and results in significantly higher short-term survival rates than do ACD CPR alone or S-CPR. Use of the ACD/ITD CPR technology optimizes perfusion of the heart and brain during cardiac arrest and results in the highest reported survival rates of any CPR device technology. Use of this technology should be encouraged while additional studies are under way to examine the potential long-term impact of this new technology.
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In industrial countries the incidence of cardiac arrest is still increasing. Almost 80% of cardiac arrest survivors remains in coma for varying lengths of time and full cerebral recovery is still a rare event. After successful cardiopulmonary resuscitation, cerebral recirculation disturbances and complex metabolic postreflow derangements lead to death of vulnerable neurons with further deterioration of cerebral outcome. This article discusses recent research efforts on the pathophysiology of brain injury caused by cardiac arrest and reviews the beneficial effect of therapeutic hypothermia on neurologic outcome along with the recent approach to prognosticate long-term outcome by electrophysiologic techniques and molecular markers of brain injury. ⋯ Electrophysiologic techniques and molecular markers of brain injury allow the accurate assessment and prognostication of long-term outcome in cardiac arrest survivors. In particular, somatosensory evoked potentials have been identified as the method with the highest prognostic reliability. A recent systematic review of 18 studies analyzed the predictive ability of somatosensory evoked potentials performed early after onset of coma and found that absence of cortical somatosensory evoked potentials identify patients not returning from anoxic coma with a specificity of 100%.