Introduction

The concept of post-resuscitation disease as a unique and new nosological entity was introduced by N.egovsky..il9Z.2). Until recently, however, the practice of cardiopulmonary resuscitation focused primarily on the success of its initial stage and therapeutic options by which a viable rhythm and spontaneous circulation would be restored. Even though the initial cardiopulmonary resuscitation success rate is approximately 39 per cent, with a range of 13 to 59 per cent across the United States, more than 60 per cent of these victims die within 24 h after initial successful resuscitation from cardiac arrest. Therefore cardiopulmonary resuscitation itself has a meaningful success rate for as few as 3 per cent of the 500 000 victims of unexpected cardiac arrest from diverse causes and at diverse sites in the United States each year. Both experimental and clinical studies have indicated that the very high post-resuscitation mortality, which averages more than 50 per cent and ranges from 44 to 71 per cent, may be related to myocardial dysfunction immediately following successful resuscitation.

Two discrete stages of cardiac resuscitation appear to exist. The first stage is that of initial resuscitation with re-establishment of a spontaneous rhythm and circulation. The second stage is that of post-resuscitation dysrhythmia and myocardial failure with increased risk of recurrent cardiac arrest ( langef al: 1993).

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