Bench to bedside: Resuscitation from prolonged ventricular fibrillation

Ventricular fibrillation (VF) remains the most common cardiac arrest heart rhythm. Defibrillation is the primary treatment and is very effective if de livered early within a few minutes of onset of VF. However, successful trea tment of VF becomes increasingly more difficult when the duration of VF exc eeds 4 minutes. Classically, successful cardiac arrest resuscitation has be en thought of as simply achieving restoration of spontaneous circulation (R OSC). However, this traditional approach fails to consider the high early p ost-cardiac arrest mortality and morbidity and ignores the reperfusion inju ries, which are manifest in the heart and brain. More recently, resuscitati on from cardiac arrest has been divided into two phases; phase I, achieving ROSC, and phase II, treatment of reperfusion injury. The focus in both pha ses of resuscitation remains the heart and brain, as prolonged VF remains p rimarily a two-organ disease. These two organs are most sensitive to oxygen and substrate deprivation and account for the vast majority of early post- resuscitation mortality and morbidity. This review focuses first on the ini tial resuscitation (achieving ROSC) and then on the reperfusion issues affe cting the heart and brain.