Post-cardiac arrest syndrome (PCAS) is the term used to describe the complex combination of problems that affect the body in the hours and days following successful resuscitation from cardiac arrest. Even after the heart has been restarted, PCAS can cause serious harm and is a major reason why many people who are resuscitated do not ultimately survive to hospital discharge.
The four components
PCAS has four overlapping elements:
Post-cardiac arrest brain injury – The brain is highly vulnerable to oxygen deprivation. Even a brief period without blood flow can cause widespread neuronal damage. This is the most common cause of death and disability after cardiac arrest and accounts for the majority of poor outcomes in survivors.
Post-cardiac arrest myocardial dysfunction – The heart itself is often stunned after the arrest, particularly if resuscitation was prolonged. Cardiac function is typically reduced in the first 24 to 72 hours but often recovers substantially with appropriate support.
Systemic ischaemia/reperfusion response – When blood flow is restored throughout the body after cardiac arrest, a reperfusion injury can occur: the return of oxygen paradoxically triggers inflammation, free radical production, and cell death. This can damage multiple organ systems simultaneously.
The precipitating pathology – The original cause of the arrest (for example, a heart attack or an arrhythmia) continues to require treatment alongside the PCAS itself.
Treatment
Management of PCAS takes place in an intensive care unit and includes targeted temperature management, haemodynamic monitoring and support, coronary intervention if indicated, and neuroprotective care. Close monitoring for seizures, organ function, and metabolic disturbances is essential.
Recovery and prognosis
The severity of PCAS and the degree of brain injury are the strongest predictors of long-term outcome. Many survivors of PCAS experience lasting cognitive, emotional, and physical difficulties even after physical recovery.
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