Microcirculation in Cardiopulmonary Resuscitation

Abstract

Even though cardiopulmonary resuscitative efforts are prompt and even if these efforts appear technically correct, some patients experiencing sudden unexpected cessation of cardiac output suffer severe and occasionally permanent neurologic deficits. The explanation has often been obscure and indicates that factors may be involved other than simply the time factor. Almost 25 years ago we reported 1,200 cases of cardiac arrest managed by open-chest cardiac compression, and indicated that only 6% of the total group of successful resuscitations had had a period of more than 4 minutes of complete cerebral anoxia (1). Once the heart stops beating, cerebral blood flow with oxygenated blood must be reinstituted within the first 4 minutes in the vast majority of instances if a successful outcome is to be expected. Un-fortunately, however, most of us have seen cases of cardiac arrest that were quickly recognized and received apparently adequate resuscitative measures but in which the patient nevertheless failed to recover and showed no signs of cerebral activity.