El-Menyar A, Wahlen BM. Cardiac arrest, stony heart, and cardiopulmonary resuscitation: An updated revisit. World J Cardiol 2024; 16(3): 126-136 [PMID: 38576519 DOI: 10.4330/wjc.v16.i3.126]
Corresponding Author of This Article
Ayman El-Menyar, MBChB, MSc, FACC, FESC, Professor, Director, Senior Scientist, Department of Trauma and Vascular Surgery, Clinical Research, Hamad Medical Corporation, Al-Rayyan Street, Doha 3050, Qatar. aymanco65@yahoo.com
Research Domain of This Article
Cardiac & Cardiovascular Systems
Article-Type of This Article
Minireviews
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Cardiol. Mar 26, 2024; 16(3): 126-136 Published online Mar 26, 2024. doi: 10.4330/wjc.v16.i3.126
Cardiac arrest, stony heart, and cardiopulmonary resuscitation: An updated revisit
Ayman El-Menyar, Bianca M Wahlen
Ayman El-Menyar, Department of Trauma and Vascular Surgery, Clinical Research, Hamad Medical Corporation, Doha 3050, Qatar
Ayman El-Menyar, Department of Clinical Medicine, Weill Cornell Medical College, Doha 24144, Qatar
Bianca M Wahlen, Department of Anesthesiology, Hamad Medical Corporation, Doha 3050, Qatar
Author contributions: El-Menyar A designed the review, performed the search and methods, and wrote and revised the manuscript; Wahlen B performed the search and wrote the manuscript.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ayman El-Menyar, MBChB, MSc, FACC, FESC, Professor, Director, Senior Scientist, Department of Trauma and Vascular Surgery, Clinical Research, Hamad Medical Corporation, Al-Rayyan Street, Doha 3050, Qatar. aymanco65@yahoo.com
Received: December 28, 2023 Peer-review started: December 28, 2023 First decision: January 17, 2024 Revised: January 17, 2024 Accepted: February 26, 2024 Article in press: February 26, 2024 Published online: March 26, 2024 Processing time: 83 Days and 20.4 Hours
Abstract
The post-resuscitation period is recognized as the main predictor of cardiopulmonary resuscitation (CPR) outcomes. The first description of post-resuscitation syndrome and stony heart was published over 50 years ago. Major manifestations may include but are not limited to, persistent precipitating pathology, systemic ischemia/reperfusion response, post-cardiac arrest brain injury, and finally, post-cardiac arrest myocardial dysfunction (PAMD) after successful resuscitation. Why do some patients initially survive successful resuscitation, and others do not? Also, why does the myocardium response vary after resuscitation? These questions have kept scientists busy for several decades since the first successful resuscitation was described. By modifying the conventional modalities of resuscitation together with new promising agents, rescuers will be able to salvage the jeopardized post-resuscitation myocardium and prevent its progression to a dismal, stony heart. Community awareness and staff education are crucial for shortening the resuscitation time and improving short- and long-term outcomes. Awareness of these components before and early after the restoration of circulation will enhance the resuscitation outcomes. This review extensively addresses the underlying pathophysiology, management, and outcomes of post-resuscitation syndrome. The pattern, management, and outcome of PAMD and post-cardiac arrest shock are different based on many factors, including in-hospital cardiac arrest vs out-of-hospital cardiac arrest (OHCA), witnessed vs unwitnessed cardiac arrest, the underlying cause of arrest, the duration, and protocol used for CPR. Although restoring spontaneous circulation is a vital sign, it should not be the end of the game or lone primary outcome; it calls for better understanding and aggressive multi-disciplinary interventions and care. The development of stony heart post-CPR and OHCA remain the main challenges in emergency and critical care medicine.
Core Tip: Despite the advances in emergency and critical care management, the outcomes post-cardiac arrest (in-hospital or out-of-hospital) remain challenging. Post-cardiac arrest myocardial dysfunction and circulatory failure are the main predictors of cardiopulmonary resuscitation outcomes. The pattern, management, and outcome of these predictors differ between subjects based on many factors. A better understanding of the pathophysiology of these two predictors is of utmost importance to achieve better post-cardiac arrest outcomes. Although restoring spontaneous circulation is a vital sign, it should not be the end of the game or lone primary outcome; it calls for aggressive multi-disciplinary interventions and care.
