Abstract

The heart is incapable of storing significant oxygen or substrates and thus is entirely dependent on a continuous delivery of flow in order to support its high metabolic state. Following cardiac arrest, myocardial tissue oxygen tension falls rapidly and aerobic production of ATP ceases. Without re-oxygenation of the ischemic myocardium, return of spontaneous circulation (ROSC) cannot be achieved. The oxygen paradox which has been described regarding other ischemia-reperfusion conditions seems to have application in cardiac arrest. It is clear that some level of oxygenation is necessary to achieve ROSC, however post ROSC there appears to be increased toxicity associated with hyperoxia. The optimal conditions for re-oxygenation in the setting of cardiac arrest remain ill defined at present.

Keywords: cardiac arrest, oxygen, myocard, oxygen delivery, Adenosine-5'-triphosphate (ATP), mitochondria, measurement of tissue oxygen, oxygen paradox

Abstract

Reversal of cardiac arrest requires reestablishment of aerobic metabolism by reperfusion with oxygenated blood of tissues that have been ischemic for variables periods of time. However, reperfusion concomitantly activates a myriad of pathogenic mechanisms causing what is known as "reperfusion injury." At the center of reperfusion injury are mitochondria, playing a critical role as effectors and targets of injury. Mitochondrial injury compromises oxidative phosphorylation and the ability to regenerate Adenosine-5'-triphosphate (ATP); i.e., bioenergetic function. Thus targeting mitochondria to protect bioenergetic function may represent a novel concept in resuscitation with the potential for altering clinical practice. We have identified sodium-hydrogen exchanger isoform-1 (NHE)-1 inhibition and erythropoietin as attractive candidate drugs for this purpose and demonstrated corresponding functional and clinical benefits. Further work on the subject may pave the way for further scientific discover focused on greater understating of underlying cell mechanisms, identification of additional and perhaps more potent strategies, and develop means for effective drug delivery.

Keywords: cardiac arrest, reperfusion injury, mitochondria, bioenergetic function, left ventricular myocardial distensibility, sodium-hydrogen exchanger isoform-1 (NHE-1) inhibitors, erythropoietin

Abstract

There is growing evidence that early detection and response to physiological deterioration can improve outcome for patients. Working out-of-hospital, we often find ourselves in diagnostic dilemmas, thus more reliable data could change our actions as well as give better assessment of patient's condition. Therefore, we are always exploring new perspectives that could be transferred from experimental laboratory settings to our primary working area in the field to help us improve decision-making leading to better outcome. In the following sections, we represent our previous studies about the utility of continuous capnometry and the importance of point-of-care ultrasound in cardiopulmonary resuscitation (CPR), and discuss about the possible future use of transthoracic and transesophageal ultrasound, point-of-care biochemical monitoring, tissue oxygen saturation, pupillometry, and mixed and central venous oxygen saturation monitoring in the prehospital setting.

Keywords: cardiopulmonary resuscitation, pre-hospital monitoring, capnometry, point-of care ultrasound and biochemical monitoring, pupillometry, mixed and central venous oxygen saturation, review

Abstract

Cardiac arrest is a dramatic condition leading to sudden death if someone cannot perform two interventions, basic life support and early defibrillation, that have been proved to improve long-term survival. The ‘Utstein style', recently introduced, represents a standard of practice both inside and outside hospital with recommended guidelines for the uniform reporting of clinical data from the patient suffering cardiac arrest. In Sweden the vast majority of patients suffering from cardiac arrest regardless whether inside or outside hospital are included in webbased national registers (one for out-of-hospital cardiac arrest (OHCA) and one for in-hospital-cardiac arrest (IHCA)). In this article we will present our experiences from OHCA and IHCA separately.

Keywords: cardiac arrest outside and inside hospital, epidemiology, The Swedish register, survival, cerebral function

Abstract

Survival after out-of-hospital cardiac arrest (OHCA) depends on a well functioning Chain of Survival. In tihis article we analysed different phases of process of improving outcome after OHCA: recognition of potential for improved survival within the local system and strictly implementation guidelines for elimination weak links. Continuous focus on the importance of a well functioning Chain of Survival with specific strategies to improve quality of care during advanced life support (ALS) and post resuscitation has lead to significantly improved outcome of patients with OHCA in Oslo.

Keywords: cardiac arrest, local Chain of Survival, improving outcome, weak links, Oslo, three different time periods