Post cardiac arrest syndrome
Citation, DOI and article data
The post cardiac arrest syndrome (PCAS) describes the clinicopathological state that manifests following most cardiac arrests. Clinically, it is manifested by a combination of neurological disturbance, multiorgan dysfunction and a systemic inflammatory response syndrome-like state.
The pathogenesis of post-cardiac arrest syndrome (PCAS) is clearly complex and remains poorly understood. In essence, during the arrest phase, organ dysfunction occurs due to ischemic injury. Following the re-establishment of normal circulation, the ischemic damage is compounded by "reperfusion injury".
As the body tissues are replenished with oxygenated blood, a mélange of activation of systemic inflammatory, clotting, endocrine and immunological cascades occurs, resulting in a state resembling the systemic inflammatory response syndrome, as seen in sepsis and with other severe systemic insults.
Moreover, contributing to this complex mix, will be the patient's original pathology which caused the arrest in the first place as well as any other co-morbidities that they might (and often) have.
The imaging features of the post cardiac arrest syndrome are myriad and non-specific, representing a medley of:
- cause of the cardiac arrest, e.g. acute PE, myocardial infarction
- ischemic sequelae of the arrest e.g. stroke
- effects of the cardiac arrest treatment e.g. rib fractures from CPR
- SIRS-like state e.g. DIC, multiorgan dysfunction
- co-morbidities, e.g. pneumonia, traumatic injuries
Treatment and prognosis
A favorable prognosis following a cardiac arrest correlates positively with careful focused attention to the blood pressure, oxygen saturation, partial pressure of carbon dioxide, blood glucose and core temperature. When these parameters are allowed to shift markedly from their normal ranges, then neurological prognosis and long term survival tend to be significantly negatively impacted. Indeed, despite optimal management, the number of post-cardiac arrest patients achieving discharge from medical care with an optimal neurological recovery remains small 1-3.
- 1. Soar J, Nolan JP. Mild hypothermia for post cardiac arrest syndrome. (2007) BMJ (Clinical research ed.). 335 (7618): 459-60. doi:10.1136/bmj.39315.519201.BE - Pubmed
- 2. Lu J, Liu L, Zhu J, Guo X. Factors Influencing the Quality of Standardized Treatment for Patients with Post-Cardiac Arrest Syndrome. (2017) Korean circulation journal. 47 (4): 455-461. doi:10.4070/kcj.2016.0437 - Pubmed
- 3. Pothiawala S. Post-resuscitation care. (2017) Singapore medical journal. 58 (7): 404-407. doi:10.11622/smedj.2017060 - Pubmed