[Pathophysiology and management of post-cardiac arrest syndrome]

Abstract

Objective: This review aims at providing an update on post-cardiac arrest syndrome, from pathophysiology to treatment.

Data sources: Medline database.

Data extraction: All data on pathophysiology, clinical manifestations and therapeutic management, with focus on the publications of the 5 last years.

Data synthesis: Care of the patients after cardiac arrest is a medical challenge, in face of "post-cardiac arrest syndrome", which culminates into multi-organ failure. This syndrome mimics sepsis-related dysfunctions, with all clinical and biological manifestations related to the phenomenon of global ischemia-reperfusion. Acute cardiocirculatory dysfunction is usually controlled through pharmacological and mechanical support. Meanwhile, as a majority of cardiac arrest is related to myocardial infarction, early angiographic exploration should then be discussed when there is no obvious extracardiac cause, percutaneous coronary revascularization being associated with improved short and long-term prognosis. Therapeutic hypothermia is the cornerstone of neuroprotective armamentarium, beyond hemodynamic stabilization and metabolic maintenance.

Conclusion: If ongoing evaluations should shed light on potential efficiency of new therapeutic drugs, a multidisciplinary approach of the post-cardiac arrest syndrome in expertise centre is essential.

Keywords: Arrêt cardiaque; Cardiac arrest; Choc; Coronarographie; Coronary angiogram; Hypothermie thérapeutique; Outcome; Pronostic; Shock; Therapeutic hypothermia.