Cardiac Arrest

Abstract

The human brain is dependent upon the delivery of oxygen and glucose and the removal of waste products for normal activity with the interruption of this cycle resulting in tissue injury. A reduction of oxygen content within the brain parenchyma is the state of anoxia, while the cessation of blood flow is ischemia. There are many different etiologies of anoxia including a reduction in blood flow-stagnant anoxia; lack of oxygenation-hypoxic anoxia; insufficient oxygen transport-anemic anoxia; and a disturbance in the intracellular oxygen transport-histotoxic anoxia. In adults the most common cause is a combined hypoxic and ischemic injury caused by cardiac arrest. For a neurological disease state with such high prevalence, surprisingly little is understood about the precise patterns of impairment or about the natural history of recovery. There are robust early predictors of outcome of anoxic-ischemic coma (Nolan et al., Intensive Care Med 41: 2039-2056, 2015; Wijdicks, Neurology 67: 203-210, 2006), but the outcome has rarely been specified beyond good, poor, and death. This chapter is designed to examine the etiology, pathology, neurological sequelae, treatment, and outcome of patients who survive a cardiac arrest.