Ischemia-reperfusion injury following cardiac arrest and protective effects of hypothermia
Authors:
P. Ošťádal
Authors place of work:
Kardiocentrum, kardiologické oddělení Nemocnice Na Homolce, Praha
Published in the journal:
Kardiol Rev Int Med 2009, 11(1): 11-15
Summary
Ischemia-reperfusion injury following cardiac arrest and protective effects of hypothermia. Early restoration of spontaneous circulation after successful cardiopulmonary resuscitation is an essential lifesaving step. However, within minutes of global ischemia, several pathways are triggered that progress even after reperfusion and may cause further damage to ischemic but viable cells (ischemia-reperfusion (IR) injury). It is desirable, therefore, besides general resuscitation care and treatment of the cause of cardiac arrest to prevent also the harmful effects of IR injury. Several pathogenic mechanisms participate in IR injury: reactive oxygen species, ion imbalance, proteases activation, induction of apoptosis, and activation of inflammation. The majority of these processes are not tissue specific and may be detectable in different organs. In ischemia very sensitive brain tissue, IR injury is enhanced by accumulation and excitotoxicity of some neurotransmiters, disruptions of bloodbrain barrier, or oedema. Together with increasing knowledge of IR mechanism, substantial efforts have been made to develop protective methods against IR injury. Many therapeutic interventions targeted against “key” mechanisms of IR injury showed very promising results in experimental studies but failed completely in clinical settings. Recently, however, one therapeutic approach has been proved to be very effective also in clinical trials: mild hypothermia. Experimental studies have shown that hypothermia exerts beneficial effects simultaneously on various parallel pathways participating in IR injury and leads to significant neuroprotection. Therapeutic hypothermia, therefore, became one of the crucial methods in the current management of patients after cardiac arrest.
Keywords:
cardiac arrest – cardiopulmonary resuscitation – ischemia-reperfusion injury – hypothermia
Zdroje
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Štítky
Paediatric cardiology Internal medicine Cardiac surgery CardiologyČlánok vyšiel v časopise
Cardiology Review
2009 Číslo 1
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