Cardiac arrest (CA) afflicts ~ 550,000 people each year in the USA. A small fraction of CA sufferers survive with a majority of these survivors emerging in a comatose state. Many CA survivors suffer devastating global brain injury with some remaining indefinitely in a comatose state. The pathogenesis of global brain injury secondary to CA is complex. Mechanisms of CA-induced brain injury include ischemia, hypoxia, cytotoxicity, inflammation, and ultimately, irreversible neuronal damage. Due to this complexity, it is critical for clinicians to have access as early as possible to quantitative metrics for diagnosing injury severity, accurately predicting outcome, and informing patient care. Current recommendations involve using multiple modalities including clinical exam, electrophysiology, brain imaging, and molecular biomarkers. This multi-faceted approach is designed to improve prognostication to avoid “self-fulfilling” prophecy and early withdrawal of life-sustaining treatments. Incorporation of emerging dynamic monitoring tools such as diffuse optical technologies may provide improved diagnosis and early prognostication to better inform treatment. Currently, targeted temperature management (TTM) is the leading treatment, with the number of patients needed to treat being ~ 6 in order to improve outcome for one patient. Future avenues of treatment, which may potentially be combined with TTM, include pharmacotherapy, perfusion/oxygenation targets, and pre/postconditioning. In this review, we provide a bench to bedside approach to delineate the pathophysiology, prognostication methods, current targeted therapies, and future directions of research surrounding hypoxic–ischemic brain injury (HIBI) secondary to CA.

中文翻译：

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复苏全球缺血性大脑：TTM 及其他。


在美国，每年约有 550,000 人遭受心脏骤停 (CA) 的困扰。一小部分 CA 患者存活下来，其中大多数幸存者处于昏迷状态。许多CA幸存者遭受毁灭性的​​全球性脑损伤，其中一些人无限期地处于昏迷状态。 CA继发的全脑损伤的发病机制很复杂。 CA 引起的脑损伤的机制包括缺血、缺氧、细胞毒性、炎症以及最终不可逆的神经元损伤。由于这种复杂性，临床医生尽早获得定量指标来诊断损伤严重程度、准确预测结果并告知患者护理至关重要。目前的建议涉及使用多种方式，包括临床检查、电生理学、脑成像和分子生物标志物。这种多方面的方法旨在改善预后，避免“自我实现”预言和过早退出维持生命的治疗。结合新兴的动态监测工具（例如漫射光学技术）可以提供改进的诊断和早期预测，从而更好地为治疗提供信息。目前，目标温度管理 (TTM) 是主要的治疗方法，为了改善一名患者的治疗效果，需要治疗约 6 名患者。未来的治疗途径可能与 TTM 相结合，包括药物治疗、灌注/氧合目标和预处理/后处理。在这篇综述中，我们提供了一个从实验到床边的方法来描述 CA 继发性缺氧缺血性脑损伤 (HIBI) 的病理生理学、预后方法、当前的靶向治疗以及未来的研究方向。