Table 1 Systemic consequences of cardiac arrest
From: Pathophysiology and clinical consequences of arterial blood gases and pH after cardiac arrest
Pathophysiology | Clinical consequences | |
|---|---|---|
Ischemia -reperfusion injury | √ Free radical formation √ Apoptosis, necrosis √ “Sterile inflammation” √ Impaired resistance to infection √ Endothelial damage √ Impaired vasoregulation √ Adrenal suppression √ Electrolytes disturbances √ Acidosis, hypoxia, catabolism | √ Multiorgan failure √ Infection/sepsis √ Microbiome disturbances √ Tissue hypoxia/ischemia √ Hyperglycemia √ Increase of intra-abdominal pressure √ Development of abdominal compartment syndrome |
Brain injury/global cerebral ischemia (GCI) | √ Calcium homeostasis disruption √ No reflow √ Pyrexia √ Hyperglycemia √ Hyperoxygenation √ Impaired cerebrovascular autoregulation √ Impairment of hypothalamic-pituitary-adrenal axis √ Raised corticotropin releasing factor (CRF)-blood flow changes | √ Damage of blood-brain barrier (BBB) (endothelial dysfunction and capillary permeability) √ Coma √ Seizures √ Cognitive dysfunction √ Stroke √ Brain death √ Pulmonary complications following cerebral ischemia (neurogenic pulmonary edema, acute distress respiratory syndrome, pneumonia) |
Myocardial dysfunction | √ Global hypokinesis √ Preserved coronary blood flow √ Elevated systemic and pulmonary vascular resistance √ Impaired ventricular function √ Decreased venous return, cardiac compliance, and cardiac output. √ Decreased contractility | √ Acute myocardial infarction (AMI) √ Arrhythmias √ Cardiomyopathies: dilated, restrictive, hypertrophic √ Cardiovascular collapse |
Arrest related lung injury | √ Reperfusion injury √ Endothelial damage √ Systemic inflammation √ Activation of clotting cascades √ Ventilation-perfusion mismatch (ventilatory pressure) √ Basal atelectasis | √ Pneumonia √ Acute respiratory distress syndrome √ Pulmonary thromboembolism |
Arrest related liver and kidney injury | √ Reperfusion injury √ Reduced blood flow √ Reduced urine output | √ Hypoxic hepatitis/acute liver failure √ Acute kidney injury |