Post-resuscitation disease--a new nosological entity. Its reality and significance.

Experimental and clinical investigations of patients resuscitated after cardiac arrest or terminal states, testify to the fact that in the post-resuscitation period alongside processes of recovery and compensation, a number of new pathological phenomena develop. The latter differ substantially from those caused by ischemia and hypoxia. These post-resuscitation processes involve not only the CNS, but also the entire body and may lead to severe disability and even death of the seemingly successfully revived body. The data available suggests that this post-resuscitation pathology is a new nosological entity--a post-resuscitation disease. This disease has it own specific etiology, pathogenesis, variants of the clinical course (a number of syndromes) and the system of treatment and rehabilitation. In view of the ever wider use of resuscitation in clinical practice, it is expedient to organize an all-round study of this nosological entity, the optimum systems of its treatment, and to include this entity into International Classification of Diseases of WHO.

Neurological aspects of reanimatology.

The science of resuscitation and correspondingly the more effective methods of death management have come up to the place of a century-old, as a rule, empirical struggle for the life of a dying human being. Mechanisms of dying and resuscitation have become the objects of comprehensive scientific research. Studies of the mechanisms of genesis of hypoxia and posthypoxic pathology of the brain have allowed us to reveal the whole complex of postischaemical factors participating in the development of post-resuscitation encephalopathies, among which the leading ones are the changes in the energy formation processes, disorders in protein and phospholipid metabolism, activation of proteolysis enzymes and changes in the state of membrane systems of neurons. Central nervous system damage is caused not only by direct influence of hypoxia in the brain, but also by a number of extracerebral factors, among which endogenous intoxication plays an important role. Restoration of cardiac activity and respiration, stabilization of metabolism help revive the brain and reverse damage caused by dying. But it is not sufficient. Neurologic therapy aimed at the restoration of brain functions is absolutely indispensable. It must be started from the moment of the patient's admission to an intensive care unit and be constantly recurred on the patient's discharge from hospital (rehabilitation therapy). Many processes occurring in the terminal period differ from those taking place in a living or even sick organism. And very often they look like processes contradicting general life conceptions. In a detailed study it becomes obvious that these contradictions are not errors in cognition or contradictions from the point of view of formal logic.(ABSTRACT TRUNCATED AT 250 WORDS)

Postresuscitation disease.

The postresuscitation disease is a specific pathophysiologic state of vital organ systems early after ischemic anoxia. This report summarizes reviews of past research and makes suggestions for future research concerning revival of the cerebral cortex after clinical death, CNS stimulation vs. sedation, postischemic coma and pain, near-death experiences, and extracerebral derangements. The stages of resuscitation when the CNS should be stimulated and those when it is preferable to depress the activity of not fully recovered higher centers remain to be clarified. Future research in reanimatology should include the chemical nature of endotoxins in terminal states. Adult respiratory distress syndrome (ARDS, shock lung), a component of the postresuscitation disease, occurs frequently after cardiac arrest or in sepsis and cannot be fully prevented by artificial ventilation. Prevention of ARDS should also be studied.

Resuscitation aspects of ultrafiltration and haemodialysis.

Results of using the method of sequential ultrafiltration with hemodialysis and that of hemodiafiltration in the treatment of 70 patients with acute and chronic renal failure in terminal states are described. The patients were under observation in the course of 202 procedures of hemodiafiltration and 175 sequential ultrafiltration with hemodialysis. Apart from this, 21 procedures of isolated ultrafiltration were carried out in patients with pronounced cardiac failure, irreversible pulmonary edema resulting from acute myocardial infarction and heart diseases. Sequential ultrafiltration and hemodialysis were performed by means of home-produced equipment SGD using Cuprofan dialysis film and capillary dialyzators. The volume of ultrafiltration ranged from 1 to 8 litres/procedure at a rate of 17-500 ml/min, at a transmembrane pressure 100-400 mmHg. It was found that sequential ultrafiltration with hemodialysis was indicated for patients in terminal states complicated by renal failure in the presence of severe fluid retention, pulmonary edema, patients with low tolerance to hemodiafiltration, and those in critical states (including irreversible pulmonary edema) of cardiological genesis.

Criteria of efficiency and safety of the defibrillating impulse.

The effectiveness and safety of the defibrillating effect of a bipolar impulse produced by a Soviet DK1-01 defibrillator and the Monopolar impulse Ed-Mark have been tested in 14 experiments on the anaesthetized dogs. A quantitative criterion to compare the safety of different defibrillators and an electro-therapeutic index of the defibrillating action are being suggested. It is defined as the ratio of the thresholds of energy in joules causing lesions to that causing defibrillation. In the above experiments the mean value of this therapeutic index was 1.59 +/- 1.41 for the Ed-Mark impulse and 4.32 +/- 2.78 for the defibrillator DK1-01 impulse. The difference of the mean values was statistically significant (P = 0.02).

Experimental extracorporeal haemabsorption in the post-resuscitation period in dogs.

Experimental extracorporeal haemabsorption in dogs, administered in the post-resuscitation period after cardiac arrest due to electro-trauma, improved the blood chemistry and diminished the acidosis considerably.