Post–Cardiac Arrest Syndrome

Robert W. Neumar, MD, PhD, Co-Chair, et al.

This scientific statement outlines current understanding and identifies knowledge gaps in the pathophysiology, treatment, and prognosis of patients who regain spontaneous circulation after cardiac arrest. The purpose is to provide a resource for optimization of post–cardiac arrest care and to pinpoint the need for research focused on gaps in knowledge that would potentially improve outcomes of patients resuscitated from cardiac arrest.

Resumption of spontaneous circulation (ROSC) after prolonged, complete, whole-body ischemia is an unnatural pathophysiologicalstate created by successful cardiopulmonary resuscitation (CPR). In the early 1970s, Dr Vladimir Negovsky recognized that thepathology caused by complete whole-body ischemia and reperfusion was unique in that it had a clearly definable cause, time course,and constellation of pathological processes.^1–3 Negovsky named this state "postresuscitation disease." Although appropriate at the time, the term "resuscitation" is now used more broadly to include treatment of various shock states in which circulation has not ceased. Moreover, the term "postresuscitation" implies that the act of resuscitation has ended. Negovsky himself stated that a second, more complex phase of resuscitation begins when patients regain spontaneous circulation after cardiac arrest.¹ For these reasons, we propose a new term: "post–cardiac arrest syndrome."/.../