Bench to bedside: resuscitation from prolonged ventricular fibrillation.
Ventricular fibrillation (VF) remains the most common cardiac arrest heart rhythm. Defibrillation is the primary treatment and is very effective if delivered early within a few minutes of onset of VF. However, successful treatment of VF becomes increasingly more difficult when the duration of VF exceeds 4 minutes. Classically, successful cardiac arrest resuscitation has been thought of as simply achieving restoration of spontaneous circulation (ROSC). However, this traditional approach fails to consider the high early post-cardiac arrest mortality and morbidity and ignores the reperfusion injuries, which are manifest in the heart and brain. More recently, resuscitation from cardiac arrest has been divided into two phases; phase I, achieving ROSC, and phase II, treatment of reperfusion injury. The focus in both phases of resuscitation remains the heart and brain, as prolonged VF remains primarily a two-organ disease. These two organs are most sensitive to oxygen and substrate deprivation and account for the vast majority of early post-resuscitation mortality and morbidity. This review focuses first on the initial resuscitation (achieving ROSC) and then on the reperfusion issues affecting the heart and brain.
Angelos
M G
MG
Department of Emergency Medicine, Ohio State University, Columbus, OH 43210-1270, USA. angelos.1@osu.edu
Menegazzi
J J
JJ
Callaway
C W
CW
D000818:Animals; D004554:Electric Countershock / Q000009:adverse effects*; D006801:Humans; D009206:Myocardium / Q000378:metabolism*; D015427:Reperfusion Injury / Q000503:physiopathology; D012151:Resuscitation / Q000379:methods*; D014693:Ventricular Fibrillation / Q000628:therapy*