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New Strategies to Improve Outcome After Cardiac Arrest

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Resuscitation

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Abstract

Cerebral and myocardial lesions account for the majority of deaths or undesirable outcomes in survivors of cardiac arrest. The sum of symptoms presented by patients has been coined post-cardiac-arrest syndrome. While several drugs and devices have failed to significantly improve outcomes in the clinical setting, mild therapeutic hypothermia has been established as gold standard in post-arrest care in recent years. The question whether therapeutic hypothermia is beneficial in comatose survivors after cardiac arrest has been sufficiently resolved. However, it remains unclear when, who, and how to cool. Novel technical devices for targeted cerebral cooling have emerged in recent years and propose improvements in post-arrest care by starting therapeutic hypothermia during cardiopulmonary resuscitation. Furthermore do animal experiments suggest that several compounds such as Xenon, Argon, Hydrogen sulfide, Nitric oxide, or Erythropoietin might exert neuroprotective effects. Results from clinical as well as basic research show that implementing cardiocirculatory rather than cardio circulatory support with hemodynamic assist devices might result in a dramatic increase in the number of returns of spontaneous circulation as well as an improved myocardial recovery in certain settings. However, all of these novel approaches in post-arrest care still have to prove, in clinical trials, whether their promised benefits hold true in real life.

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Authors and Affiliations

  1. Department of Anesthesiology, University Hospital RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Germany

    Matthias Derwall, Anne Brücken & Michael Fries

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  1. Matthias Derwall
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  2. Anne Brücken
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  3. Michael Fries
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Correspondence to Michael Fries .

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Editors and Affiliations

  1. UCO di Anestesia e Rianimazione, Azienda Ospedaliero-Universitaria Policlinico Vittorio Emanuele, Catania, Italy

    Antonino Gullo

  2. Dept. Cardiovascular research, Istituto Mario Negri, Milano, Milano, Italy

    Giuseppe Ristagno

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Derwall, M., Brücken, A., Fries, M. (2014). New Strategies to Improve Outcome After Cardiac Arrest. In: Gullo, A., Ristagno, G. (eds) Resuscitation. Springer, Milano. https://doi.org/10.1007/978-88-470-5507-0_17

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  • DOI: https://doi.org/10.1007/978-88-470-5507-0_17

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