Book contents
- Frontmatter
- Contents
- List of contributors
- Foreword
- Preface
- Part I Introduction
- Part II Basic science
- Part III The pathophysiology of global ischemia and reperfusion
- Part IV Therapy of sudden death
- 23 Prevention of sudden cardiac death
- 24 Sequence of therapies during resuscitation: application of CPR
- 25 Transthoracic defibrillation
- 26 Automated external defibrillators
- 27 Public access defibrillation
- 28 The physiology of ventilation during cardiac arrest and other low blood flow states
- 29 Airway techniques and airway devices
- 30 Manual cardiopulmonary resuscitation techniques
- 31 Mechanical devices for cardiopulmonary resuscitation
- 32 Invasive reperfusion techniques
- 33 Routes of drug administration
- 34 Adrenergic agonists
- 35 Vasopressin and other non-adrenergic vasopressors
- 36 Antiarrhythmic therapy during cardiac arrest and resuscitation
- 37 Acid–base considerations and buffer therapy
- 38 Cardiac arrest resuscitation monitoring
- 39 Special considerations in the therapy of non-fibrillatory cardiac arrest
- 40 Cardiocerebral resuscitation: a new approach to out-of-hospital cardiac arrest
- 41 Thrombolysis during resuscitation from cardiac arrest
- 42 Percutaneous coronary intervention (PCI) after successful reestablishment of spontaneous circulation and during cardiopulmonary resuscitation
- 43 Emergency medical services systems and out-of-hospital cardiac arrest
- 44 In-hospital resuscitation
- 45 Complications of CPR
- 46 Bringing it all together: state-of-the-art therapy for cardiac arrest
- Part V Postresuscitation disease and its care
- Part VI Special resuscitation circumstances
- Part VII Special issues in resuscitation
- Index
37 - Acid–base considerations and buffer therapy
from Part IV - Therapy of sudden death
Published online by Cambridge University Press: 06 January 2010
- Frontmatter
- Contents
- List of contributors
- Foreword
- Preface
- Part I Introduction
- Part II Basic science
- Part III The pathophysiology of global ischemia and reperfusion
- Part IV Therapy of sudden death
- 23 Prevention of sudden cardiac death
- 24 Sequence of therapies during resuscitation: application of CPR
- 25 Transthoracic defibrillation
- 26 Automated external defibrillators
- 27 Public access defibrillation
- 28 The physiology of ventilation during cardiac arrest and other low blood flow states
- 29 Airway techniques and airway devices
- 30 Manual cardiopulmonary resuscitation techniques
- 31 Mechanical devices for cardiopulmonary resuscitation
- 32 Invasive reperfusion techniques
- 33 Routes of drug administration
- 34 Adrenergic agonists
- 35 Vasopressin and other non-adrenergic vasopressors
- 36 Antiarrhythmic therapy during cardiac arrest and resuscitation
- 37 Acid–base considerations and buffer therapy
- 38 Cardiac arrest resuscitation monitoring
- 39 Special considerations in the therapy of non-fibrillatory cardiac arrest
- 40 Cardiocerebral resuscitation: a new approach to out-of-hospital cardiac arrest
- 41 Thrombolysis during resuscitation from cardiac arrest
- 42 Percutaneous coronary intervention (PCI) after successful reestablishment of spontaneous circulation and during cardiopulmonary resuscitation
- 43 Emergency medical services systems and out-of-hospital cardiac arrest
- 44 In-hospital resuscitation
- 45 Complications of CPR
- 46 Bringing it all together: state-of-the-art therapy for cardiac arrest
- Part V Postresuscitation disease and its care
- Part VI Special resuscitation circumstances
- Part VII Special issues in resuscitation
- Index
Summary
Introduction
Both respiratory (hypercarbic) and metabolic acidosis are important components of cardiac arrest pathophysiology, and resuscitation measures aim to ameliorate or to counteract their potentially harmful effects. The acid–base derangements of cardiac arrest and CPR are exceptionally complicated because of the distinctive kinetics of carbon dioxide during the low-flow state of CPR. On the basis of this physiology, far-reaching hypotheses regarding buffer therapy in general and bicarbonate in particular have been considered and have profoundly affected clinical practice for the past two decades. These hypotheses, however, have not been substantiated by firm published data, resulting in rather ambiguous official recommendations and an atmosphere of uncertainty in the field.
The main objectives of this chapter are to discuss the complicated acid–base derangements of cardiac arrest and CPR and their effects on critical body systems, and to clarify ambiguities regarding buffer therapy.
The discussion in this chapter is limited to acid–base considerations in the context of cardiac arrest and CPR, and not in other contexts of metabolic acidosis, such as hypoxia with adequate tissue perfusion, shock, or ketoacidosis. Despite some similarities, the pathophysiology of these conditions differs markedly from that of cardiac arrest and direct extrapolation might lead to erroneous conclusions.
Historical perspectives
In their original 1961 “Report of Application of External Cardiac Massage in 118 Patients”1 Jude, Kouwenhoven and Knickerbocker wrote: “Continued cardiac arrest, even though the circulation is artificially maintained, will result in metabolic acidosis.
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- Cardiac ArrestThe Science and Practice of Resuscitation Medicine, pp. 674 - 697Publisher: Cambridge University PressPrint publication year: 2007
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