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post-cardiac arrest syndrome:Mechanisms and evaluation of adrenal insufficiency

World Journal of Critical Care Medicine 2012年第1期1卷 4-9页

作者： Athanasios Chalkias Theodoros Xanthos Department of Anatomy Medical School University of Athens 11527 Athens Greece

cardiac arrest is one of the leading causes of death and represents maximal stress in humans. After restoration of spontaneous circulation, post-cardiac arrest syndrome is the predominant disorder in survivors. Besides the post-arrest brain injury, the post-resuscitation myocardial stunning, and the systemic ischemia/reperfusion response, this syndrome is characterized by adrenal insufficiency, a disorder that often remains undiagnosed. The pathophysiology of adrenal insufficiency has not been elucidated. We performed a comprehensive search of three medical databases in order to describe the major pathophysiological disturbances which are responsible for the occurrence of the disorder. Based on the available evidence, this article will help physicians to better evaluate and understand the hidden yet deadly post-cardiac arrest adrenal insufficiency.

关键词： Adrenal insufficiency cardiac arrest postresuscitation period post-cardiac arrest syndrome

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Electrocardiographic changes during induced therapeutic hypothermia in comatose survivors after cardiac arrest

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World Journal of Cardiology 2015年第7期7卷 423-430页

作者： Pablo Salinas Esteban Lopez-de-Sa Laura Pena-Conde Ana Viana-Tejedor Juan Ramon Rey-Blas Eduardo Armada Jose Luis Lopez-Sendon Instituto Cardiovascular Hospital Clínico San Carlos Acute cardiac Care Unit Division of CardiologyHospital Universitario La Paz

AIM: To assess the safety of therapeutic hypothermia(TH) concerning arrhythmias we analyzed serial electrocardiograms(ECG) during ***: All patients recovered from a cardiac arrest with Glasgow cardiac arrest during the study period,47 patients had the 3 ECG and telemetry data available. ECG analysis was blinded and performed with manual caliper by two independent cardiologists from blinded copies of original ECG,recorded at 25 mm/s and 10 mm/m V. Coronary care unit staff analyzed ECG telemetry for rhythm disturbances. Variables measured in ECG were rhythm,RR,PR,QT and corrected QT(QTc by Bazett formula,measured in lead v2) intervals,QRS duration,presence of Osborn's J wave and U wave,as well as ST segment displacement and T wave amplitude in leads Ⅱ,v2 and ***: Heart rate went down an average of 19 bpm during hypothermia and increased again 16 bpm with rewarming(P < 0.0005,both). There was a nonsignificant prolongation of the PR interval during TH and a significant decrease with rewarming(P = 0.041). QRS duration significantly prolonged(P = 0.041) with TH and shortened back(P < 0.005) with rewarming. QTc interval presented a mean prolongation of 58 ms(P < 0.005) during TH and a significant shortening with rewarming of 22.2 ms(P = 0.017). Osborn or J wave was found in 21.3% of the patients. New arrhythmias occurred in 38.3% of the patients. Most frequent arrhythmia was non-sustained ventricular tachycardia(19.1%),followed by severe bradycardia or paced rhythm(10.6%),accelerated nodal rhythm(8.5%) and atrial fibrillation(6.4%). No life threatening arrhythmias(sustained ventricular tachycardia,polymorphic ventricular tachycardia or ventricular fibrillation) occurred during TH.

关键词： cardiac arrest Therapeutic hypothermia post-cardiac arrest síndrome cardiac arrythmias QT interval

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