HHE Emergency care supplement 2018 - Page 22

Every effort should be made to reduce the secondary reperfusion injury to the brain – during this ischaemia– reperfusion time, it is suspected that ATP molecules are reduced in the brain and anaerobic glycolysis occurs morbidity and mortality for OHCA. However once primary neurological insult has occurred, there should be every effort made to reduce the secondary reperfusion injury to the brain. The mechanism of this inju H\YBݙ\YHYHYX[ܛX][ۈ[[[[X]ܞHYYX]ܜX\H[[\]Z[LK L\[\\Y[ZXx$ܙ\\\[ۂ[YK]\\XY]U[X[\\BYXY[HZ[[[Y\ؚXX\\›\]\[[X[[\][و]KY[[X]H\N\[\XYš[KH[^X[[\XY\[X\]Y[B[\\[X] L]\ۛۈ[[[X[]\H\YX[ۂ[\X[Y]XX]H܈Y[ T HقH܈]\H KYYܙYHYX[ۈ[Z[[\\]\H 0 K LH]\[ܚ\Y]B[\YZ[[H\YܙHHXY[\ܚ]X[ \\\]][ۈ\[ \H\[™]Y[H]H 8$KY[ܙX\H[Y[YX[X^HH\[[\\\ZXK LX\]Y[H\\Y\YHHX܈[H\\\ZX]Y[Y\[H]B[[ܙX\Y[ܝ[]H]H[[Y[Hق]\X[\][YK L\X][ۜ•[H[X[\\ZXH܈HY[\˜۝^HX[ۋ]\]]\ˈB[YYHYX܈\X]Y[[BH]\\\]\[[X]H\\[K]\[ ]\[YY܈]\H[^][ۋ\X\[Z^\HX]]JH\XX™\ܚ]ZXKYY[[[[][H\\[ۋH]Y]\Y\[ݘ\[\\X][ۜ\H[Z[H\]Y[YY\YHœKY^\[\Y[ZXX\\X\H R B^X\]YHHY[[[[ZX[X[[B]\YHK MۙH^H\XHو\X][ۈ]H\™XHY[\\XYX[H][[[\\[H[YXY[[[Xܙ][ۈXY[\\XY[ZXN\]\\[[ܙX\H[B]Hو[X[ۜ]\]H[[[Z[\Kݙ\[[ܘY]H[[ܝ[]H\Y[ۂHY\]\\XY[ZXH[Hܚ]X[B[[][ۈ[\YܙHH[ۚ]ܚ[[\X]HX[Y[Y[و\\XY[ZXB[H[\Z[]K M[\][ H\HHۘ[]Y^H[\[ۈ]\XXH]H[[[Y[YH۝XH][][H\]Y[KX\]Y\•HX\ۈH\\XYU܈\œXHH[\ܝ[HۈY[[H[\\]\Bٚ[H܈H]Y[ X[\[][Z\\[X[\ۜK MH][H]YY[YH\\΂H[X[ۈ8$[[[[ۘ[[HB\[[\\]\HH\ۙBXZ[[[H8$XZ[Z[[H][\\]\H܈H\\Y[YB]\Z[8$[[H]›ܛ[\ZX[\\]\H[YHH[ܙX\[[\\]\H]H]]K\X\^\ۈH[X[[YHš[Y]HK][و\][ۈ[]\Z[[YK]YHYY\][\ܛZ[KZ][U [ܝ[][BH N][X[\KB]][Y]ۙ]\H\][܂\X[]K M[X\HYY\Y[YYۘYH]B[H\Y\X\H\\X\XHXNš]\H[Z\Y ۝YX[YݙH[H[Y][\\وYYXY]BU[\\\ۈH[]Y[Hق\\\ZXK M•\H\H\[HYHXZ[X\]Y\˜]Z[XH܈[ SK\H\B[[X\\Y[[H]Z[X[]HوXX\Y\\[[ۈ][ۈ[ۈ[[X[\[\[\΂H۝[[ۘ[[Y]Œ\XH[\[\Œ[]\[\[\[\˂۝[[ۘ[[Y]•\HY][YHܝ\YXKXHY[H[\[ۈوZY \H]HBY[YHوZ[X\ [HX\XK[[H\Y[X[][ۈ]\Y]˂\HY]]\\HY]]ܝYK[[H[]Y[H\H܈Y\]X][H\[[\\]\H\]Z[XK N^H[YXB[\\]\H[\\Y][[HYX[\H[XZ[[[Hو\\Y[\\]\B[K\XH[Y]•\H]X\ؘXHH[[[ۛB]Z[XKܚH\[][ZY܈Z\YZ]\[]܈Yܘ\Y܂\YYH]Y[ H\و]X\^\[]X\H\]ܘ\]ܚ]BUK[ R]][]RRHB[[]HXV\\H[\H[\H[\[\X[HYY][H\B^[\\وY]X\H]\\[BZ[\Y[\][ HY[Y\و\H]X\\H]^B\HX\H\H[\YH[]X]HX]Y[ [H[ٙ\[]]YYYXYX[\\˜Y\]\܈Z\[\\]\HXܙ[H[Y\[]]Y[\\Y[H[[ܙH[\\]\H[ܜ˂[ܝ[][H]\[\[[[ۈ]\H]X\ NHXZYX\]]H]\B[^][ۋ\H\[HX[]Hو[\]][ۈ[\[Y\H\H\K NB[]\[\[Y]•\HY][HH[[][ۈوB[[Z[XY\]]ۈ\[\X][ۜ[H[X[ۋYY[[X\ˈ][YHوܚ][H\[X\  H[[\ [\H\HHXZ܂]X\[\KH\[X\\HYY[Y]و][H\H[Y[[\[ۈ]]\X[Y]][\[H]Y[BYY܈][\H[\ˈHܙX]\[Y]\\Z[Y]\H]X\\X\B[\\]\H۝[XZ[[[H[]\Z[\\[\]\[ˈ \\\ۈو[Y]۝[[ۘ[Y]\YKHX[]X]HYHY]\XH[›Y]\\[]\[\[]X\ˈ BH[[\\Y[YYY\H\[H[]YH[Z]\[ܝ[]H܈]\X[