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Despite cardiopulmonary resuscitation guidelines and their regular updates, the results of cardiac arrest victims treatment are still disappointingly poor. Complex treatment including providing artificial ventilation, circulatory support and prevention of secondary damage from ischemia and hypoxia is a complicated process and its result is unpredictable. The aim of the paper is to present the main steps in post-resuscitation syndrome treatment including ventilatory and circulatory stabilization, central nervous system protection and prognostic value of biochemical and neurophysiological tests.

The decreased immunity which occurs frequently in severely intoxicated patients may led to sepsis. The sepsis may be caused by bacterial toxins in unconscious patients with toxic coma which generate decreased immunity. Apart from the wide spectrum antibiotic therapy, crystalloids, colloids, vasopressin and corticosteroids, the renal replacement therapy may be useful in treatment of sepsis due to its complexes pathophysiology. Taking into account the role of cytokines in sepsis pathomechanism, the trials of treatment using high cut-off (HCO) membranes were performed in the recent years. These membranes remove molecules with mass up to 60 kDa, including cytokines typical for severe sepsis. The usefulness of continuous veno-venous hemodialysis--CVVHD with HCO dialyzer in the treatment of patient in septic shock and multiorgan damage--including damage caused by cardiac arrest was presented in the study. The concentration of IL-1P, IL-2, IL-4, IL-6, IL-10, IL-12, INF-alpha, INF-gamma, TGF-alpha in blood were determined before and after the 24-hours procedure. After the procedure the most evident decrease was observed for IL-4, 6, 10, 12 (17.3%, 31.8%, 83.4% i 22.3% respectively). During the following days the general status of patient improved gradually. The patient was discharged from the hospital after 20 days of hospitalization. His general condition was good, the values of inflammatory parameters were normal and the renal function was correct. There are very few studies describing HCO membranes effectiveness and they were performed on limited populations of patients. The presented case study may contribute to the discussion on the usefulness of dialysis with HCO membranes in the treatment of severely intoxicated patients complicated by serious sepsis resistant to standard antibiotic therapy.

The authors discuss the usefulness of therapeutic hypothermia for neuroprotection in patients with hypoxic cerebral damage. Although first reports on this method were published more than 50 years ago, it gained wider popularity at the end of 20th century. This popularity was related to the fact that deep hypothermia (below 30 degrees C) was displaced by mild hypothermia using higher temperatures (32-35 degrees C). The therapeutic benefit of mild hypothermia is based on the decrease of cerebral metabolism (5-7% per one degree Celsius). The ATP consumption by neurons is decreased despite the lack of glucose and oxygen associated with cardiac arrest, and membrane function is longer preserved. Hypothermia also prevents cerebral oedema, both of vascular and cytotoxic origin, and other reactions associated with reperfusion injury. Recently, the American Heart Association and European Resuscitation Council recommended the use of mild hypothermia (32-34 degrees C) in adult patients after ventricular fibrillation. Some clinical data also indicates that induced hypothermia reduces cerebral hypoxic ischemic injury. Randomized clinical trials in newborns with hypoxic ischemic encephalopathy confirm improved neurological outcomes and survival at 18 months of age with therapeutic hypothermia. The use of hypothermia after craniocerebral and spinal trauma, or ischemic brain damage is controversial, and not widely recommended. The authors describe various methods of inducing hypothermia in clinical settings; perhaps the most effective is intravenous infusion of cold fluids together with superficial cooling. Side effects and complications are discussed. They conclude that mild hypothermia can be regarded as a useful therapy in adult patients after VF cardiac arrest, and in neonates with hypoxic cerebral brain damage.

Background: The Tako-Tsubo syndrome is characterized by a transient left ventricular dysfunction in the absence of obstructive coronary disease, typically precipitated by severe emotional or physical stress. It is characterized by a balloon-like left ventricular appearance on angiography, ECG changes, and elevated cardiac biomarkers. We describe a case, where Tako-Tsubo cardiomyopathy was diagnosed in a patient with subarachnoid haemorrhage., Case Report: A 57-year-old man was brought to the hospital after cardiac arrest and successful resuscitation. After admission, echocardiography was performed that revealed marked impairment of contractility of the left ventricle with akinesis of the apex, interventricular septum, and anterior wall. Subsequent coronary angiography revealed neither coronary pathology nor pulmonary embolism; however, ventriculography showed typical dynamics of the Tako-Tsubo syndrome. Because of a deep cerebral coma (GSG 3), a CT-scan was performed that revealed subarachnoid haemorrhage with a haemotoma in the left temporal lobe, together with symptoms of massive cerebral oedema. The patient died eight days later despite vigorous intensive care. During the autopsy, a ruptured aneurysm of the left central cerebral artery was found., Conclusions: The Tako-Tsubo syndrome may occur not only during serious stress but also after resuscitation of cardiac arrest following cerebral bleeding.

Background: Severe hyperkalaemia may be life-threatening, especially in patients with renal failure who are unable to excrete potassium. Various therapies including intravenous sodium bicarbonate, insulin/glucose infusion as well as several beta-2 agonists have been proposed for management of hyperkalaemia. However, if the potassium concentration increases rapidly and the situation becomes critical, haemodialysis may be used. External cardiac compressions can provide adequate blood flow., Case Report: We report a case of a 53-year-old male drunk, multiple trauma patient who was admitted after falling from the tree 40 h earlier. Patients was tetraplegic and anuric. His serum potassium concentration was 8.5 mmol L(-1). Shortly after admittance he arrested and standard CPR was commenced. Because of hyperkalaemia veno-venous haemodialysis was initiated via the internal jugular vein. Blood flow was adequate. After 40 min of resuscitation serum potassium decreased to 5.44 mmol L(-1) and spontaneous sinus rhythm returned. Patient regained consciousness and could move his limbs. After another four dialysis he recovered completely., Conclusion: Haemodialysis should be considered as a rescue method during hyperkalaemic cardiac arrest if standard CPR and treatment of hyperkalaemia is not effective, even if there is no spontaneous circulation present.

Background: Tension pneumothorax is an absolute contraindication to hyperbaric oxygenation (HBO). During the decompression, at the end of the hyperbaric session, the increase in gas volume related to decreasing the pressure in the chamber can induce tension pneumothorax. The risk can be minimised, when pleural cavities have been drained before the session., Case Report: A 13-year-old girl was admitted to the Hyperbaric Intensive Therapy Unit after carbon monoxide poisoning and subsequent drowning in a bath and cardiac arrest. She was resuscitated at the site of the accident and transferred to the hyperbaric centre. On admission, she was deeply unconscious, hypothermic, her GCS was 3, and her pupils were non-reacting and maximally dilated. COHb concentration was 48.7%, and X-ray revealed pulmonary oedema. She arrested again and HBO was started during CPR. After 30 min, spontaneous circulation returned and her COHb concentration decreased to 25.6%. During the next 6 h, COHb decreased to 6.5%. The patient developed severe ARDS, and HBO sessions were continued. During the fourth session, the HBO team became aware of an earlier chest x-ray showing a left-sided tension pneumothorax. Emergency decompression was attempted, but it resulted in rapid enlargement of the pneumothorax and deterioration in the patient's condition. The pressure in the chamber was immediately increased and a thoracic drain inserted by the attending anaesthesiologist. Further decompression was uneventful.Despite intensive treatment, the girl died after 85 h of treatment because of severe ARDS., Discussion: Despite initial successful resuscitation, the girl died, primarily due to severe ARDS that was probably related to the near-drowning and repeated CPR. In such cases it is essential to be able to react quickly inside the chamber and an attending anaesthesiologist should be always present in the chamber during HBO sessions.

A 74-year-old patients is described who had typical attacks of glossopharyngeal neuralgia associated with very frequent episodes of cardiac arrest. Pacemaker implantation made possible controlling of episodes of cardiac arrest while full remission of attacks was obtained after carbamazepine treatment 900 mg daily.