Anoxic brain injury overview: Difference between revisions
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==Overview== | ==Overview== | ||
Anoxic brain injury or post-cardiac arrest is defined as absence of [[pulse]]s requiring chest compressions, regardless of location or presenting rhythm. Post-cardiac arrest syndrome is characterized by resumption of spontaneous [[systemic]] [[circulation]] after prolonged [[ischemia]] of whole body.<ref name="pmid18948368">{{cite journal| author=Neumar RW, Nolan JP, Adrie C, Aibiki M, Berg RA, Böttiger BW et al.| title=Post-cardiac arrest syndrome: epidemiology, pathophysiology, treatment, and prognostication. A consensus statement from the International Liaison Committee on Resuscitation (American Heart Association, Australian and New Zealand Council on Resuscitation, European Resuscitation Council, Heart and Stroke Foundation of Canada, InterAmerican Heart Foundation, Resuscitation Council of Asia, and the Resuscitation Council of Southern Africa); the American Heart Association Emergency Cardiovascular Care Committee; the Council on Cardiovascular Surgery and Anesthesia; the Council on Cardiopulmonary, Perioperative, and Critical Care; the Council on Clinical Cardiology; and the Stroke Council. | journal=Circulation | year= 2008 | volume= 118 | issue= 23 | pages= 2452-83 | pmid=18948368 | doi=10.1161/CIRCULATIONAHA.108.190652 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18948368 }} </ref> [[anoxia|Anoxic]] or [[hypoxic]] brain injury is often seen after [[cardiac arrest]] as part of the post-[[cardiac arrest]] [[syndrome]]. Major efforts are underway to improve "The Chain of Survival" based upon early access to medical care, early [[defibrillation]], early [[CPR]] and early hospital care. [[Therapeutic]] [[hypothermia]] may improve outcomes. [[Steroid]]s, [[mannitol]], [[diuresis]] and [[hyperventilation]] have not been documented to meaningfully improve clinical outcomes. | Anoxic brain injury or post-cardiac arrest is defined as absence of [[pulse]]s requiring chest compressions, regardless of location or presenting rhythm. Post-cardiac arrest syndrome is characterized by resumption of spontaneous [[systemic]] [[circulation]] after prolonged [[ischemia]] of whole body.<ref name="pmid18948368">{{cite journal| author=Neumar RW, Nolan JP, Adrie C, Aibiki M, Berg RA, Böttiger BW et al.| title=Post-cardiac arrest syndrome: epidemiology, pathophysiology, treatment, and prognostication. A consensus statement from the International Liaison Committee on Resuscitation (American Heart Association, Australian and New Zealand Council on Resuscitation, European Resuscitation Council, Heart and Stroke Foundation of Canada, InterAmerican Heart Foundation, Resuscitation Council of Asia, and the Resuscitation Council of Southern Africa); the American Heart Association Emergency Cardiovascular Care Committee; the Council on Cardiovascular Surgery and Anesthesia; the Council on Cardiopulmonary, Perioperative, and Critical Care; the Council on Clinical Cardiology; and the Stroke Council. | journal=Circulation | year= 2008 | volume= 118 | issue= 23 | pages= 2452-83 | pmid=18948368 | doi=10.1161/CIRCULATIONAHA.108.190652 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18948368 }} </ref> [[anoxia|Anoxic]] or [[hypoxic]] brain injury is often seen after [[cardiac arrest]] as part of the post-[[cardiac arrest]] [[syndrome]]. Major efforts are underway to improve "The Chain of Survival" based upon early access to medical care, early [[defibrillation]], early [[CPR]] and early hospital care. [[Therapeutic]] [[hypothermia]] may improve outcomes. [[Steroid]]s, [[mannitol]], [[diuresis]] and [[hyperventilation]] have not been documented to meaningfully improve clinical outcomes. | ||
==Pathophysiology== | |||
There are a variety of factors that contribute to anoxic brain injury. The primary mechanism for injury is a result of a lack of oxygen to the brain, therefore any condition which causes this, such as [[cardiac arrest]] or [[airway obstruction]], can cause anoxic brain injury. | |||
==Diagnosis== | ==Diagnosis== | ||
===CT=== | ===CT=== | ||
Revision as of 19:41, 11 February 2013
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Anoxic brain injury or post-cardiac arrest is defined as absence of pulses requiring chest compressions, regardless of location or presenting rhythm. Post-cardiac arrest syndrome is characterized by resumption of spontaneous systemic circulation after prolonged ischemia of whole body.[1] Anoxic or hypoxic brain injury is often seen after cardiac arrest as part of the post-cardiac arrest syndrome. Major efforts are underway to improve "The Chain of Survival" based upon early access to medical care, early defibrillation, early CPR and early hospital care. Therapeutic hypothermia may improve outcomes. Steroids, mannitol, diuresis and hyperventilation have not been documented to meaningfully improve clinical outcomes.
Pathophysiology
There are a variety of factors that contribute to anoxic brain injury. The primary mechanism for injury is a result of a lack of oxygen to the brain, therefore any condition which causes this, such as cardiac arrest or airway obstruction, can cause anoxic brain injury.
Diagnosis
CT
In the early hours and days after anoxic brain injury, there is often diffuse cerebral edema and blurring of the border between the grey and white matter. In some patients there may be discrete infarcts after a few days.
Electroencephalogram
Most often the EEGs of patients in coma after cardiac arrest shows diffuse slowing of both the theta and delta waves, and periodic epileptiform firing. Severe slowing or a flat line appearance is associated with a poor prognosis.
References
- ↑ Neumar RW, Nolan JP, Adrie C, Aibiki M, Berg RA, Böttiger BW; et al. (2008). "Post-cardiac arrest syndrome: epidemiology, pathophysiology, treatment, and prognostication. A consensus statement from the International Liaison Committee on Resuscitation (American Heart Association, Australian and New Zealand Council on Resuscitation, European Resuscitation Council, Heart and Stroke Foundation of Canada, InterAmerican Heart Foundation, Resuscitation Council of Asia, and the Resuscitation Council of Southern Africa); the American Heart Association Emergency Cardiovascular Care Committee; the Council on Cardiovascular Surgery and Anesthesia; the Council on Cardiopulmonary, Perioperative, and Critical Care; the Council on Clinical Cardiology; and the Stroke Council". Circulation. 118 (23): 2452–83. doi:10.1161/CIRCULATIONAHA.108.190652. PMID 18948368.