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Alterations in Cerebral Blood Flow after Resuscitation from Cardiac Arrest
Greater than 50% of patients successfully resuscitated from cardiac arrest have evidence of neurological disability. Numerous studies in children and adults, as well as in animal models have demonstrated that cerebral blood flow (CBF) is impaired after cardiac arrest. Stages of cerebral perfusion po...
Autores principales: | , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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Frontiers Media S.A.
2017
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5561008/ https://www.ncbi.nlm.nih.gov/pubmed/28861407 http://dx.doi.org/10.3389/fped.2017.00174 |
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author | Iordanova, Bistra Li, Lingjue Clark, Robert S. B. Manole, Mioara D. |
author_facet | Iordanova, Bistra Li, Lingjue Clark, Robert S. B. Manole, Mioara D. |
author_sort | Iordanova, Bistra |
collection | PubMed |
description | Greater than 50% of patients successfully resuscitated from cardiac arrest have evidence of neurological disability. Numerous studies in children and adults, as well as in animal models have demonstrated that cerebral blood flow (CBF) is impaired after cardiac arrest. Stages of cerebral perfusion post-resuscitation include early hyperemia, followed by hypoperfusion, and finally either resolution of normal blood flow or protracted hyperemia. At the level of the microcirculation the blood flow is heterogeneous, with areas of no flow, low flow, and increased flow. CBF directed therapies in animal models of cardiac arrest improved neurological outcome, and therefore, the alterations in CBF after cardiac arrest likely contribute to the development of hypoxic ischemic encephalopathy. Current intensive care after cardiac arrest is centered upon maintaining systemic oxygenation, normal blood pressure values for age, maintaining general homeostasis, and avoiding hyperthermia. Assessment of CBF and oxygenation is not routinely performed after cardiac arrest. Currently available and underutilized techniques to assess cerebral perfusion include transcranial doppler, near-infrared spectroscopy, and arterial spin labeling magnetic resonance imaging. Limited clinical studies established the role of CBF and oxygenation monitoring in prognostication after cardiac arrest and few studies suggest that guiding critical care post-resuscitation to mean arterial pressures above the minimal autoregulatory range might improve outcome. Important knowledge gaps thus remain in cerebral monitoring and CBF and oxygen goal-directed therapies post-resuscitation from cardiac arrest. |
format | Online Article Text |
id | pubmed-5561008 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2017 |
publisher | Frontiers Media S.A. |
record_format | MEDLINE/PubMed |
spelling | pubmed-55610082017-08-31 Alterations in Cerebral Blood Flow after Resuscitation from Cardiac Arrest Iordanova, Bistra Li, Lingjue Clark, Robert S. B. Manole, Mioara D. Front Pediatr Pediatrics Greater than 50% of patients successfully resuscitated from cardiac arrest have evidence of neurological disability. Numerous studies in children and adults, as well as in animal models have demonstrated that cerebral blood flow (CBF) is impaired after cardiac arrest. Stages of cerebral perfusion post-resuscitation include early hyperemia, followed by hypoperfusion, and finally either resolution of normal blood flow or protracted hyperemia. At the level of the microcirculation the blood flow is heterogeneous, with areas of no flow, low flow, and increased flow. CBF directed therapies in animal models of cardiac arrest improved neurological outcome, and therefore, the alterations in CBF after cardiac arrest likely contribute to the development of hypoxic ischemic encephalopathy. Current intensive care after cardiac arrest is centered upon maintaining systemic oxygenation, normal blood pressure values for age, maintaining general homeostasis, and avoiding hyperthermia. Assessment of CBF and oxygenation is not routinely performed after cardiac arrest. Currently available and underutilized techniques to assess cerebral perfusion include transcranial doppler, near-infrared spectroscopy, and arterial spin labeling magnetic resonance imaging. Limited clinical studies established the role of CBF and oxygenation monitoring in prognostication after cardiac arrest and few studies suggest that guiding critical care post-resuscitation to mean arterial pressures above the minimal autoregulatory range might improve outcome. Important knowledge gaps thus remain in cerebral monitoring and CBF and oxygen goal-directed therapies post-resuscitation from cardiac arrest. Frontiers Media S.A. 2017-08-16 /pmc/articles/PMC5561008/ /pubmed/28861407 http://dx.doi.org/10.3389/fped.2017.00174 Text en Copyright © 2017 Iordanova, Li, Clark and Manole. http://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. |
spellingShingle | Pediatrics Iordanova, Bistra Li, Lingjue Clark, Robert S. B. Manole, Mioara D. Alterations in Cerebral Blood Flow after Resuscitation from Cardiac Arrest |
title | Alterations in Cerebral Blood Flow after Resuscitation from Cardiac Arrest |
title_full | Alterations in Cerebral Blood Flow after Resuscitation from Cardiac Arrest |
title_fullStr | Alterations in Cerebral Blood Flow after Resuscitation from Cardiac Arrest |
title_full_unstemmed | Alterations in Cerebral Blood Flow after Resuscitation from Cardiac Arrest |
title_short | Alterations in Cerebral Blood Flow after Resuscitation from Cardiac Arrest |
title_sort | alterations in cerebral blood flow after resuscitation from cardiac arrest |
topic | Pediatrics |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5561008/ https://www.ncbi.nlm.nih.gov/pubmed/28861407 http://dx.doi.org/10.3389/fped.2017.00174 |
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