Improving Outcome of Cardiac Arrest: from Cardiopulmonary Resuscitation Interventions to Post Resuscitation Care

The present thesis focuses on different strategies targeting the two main aspects of cardiac arrest (CA) treatment, namely: cardiopulmonary resuscitation interventions and post-resuscitation care. It includes both experimental and translational studies directed to improve hemodynamic support during CPR, to define pulmonary dysfunction related to CPR, and to improve post-resuscitation outcomes. 1. In this experimental study, we sought to investigate the hemodynamic support generated by a mechanical piston device or manual chest compression (CC) in a moving ambulance. The hypothesis on whether mechanical CC would improve systemic perfusion compared with manual CC was tested in a preclinical porcine model of out-of-hospital cardiac arrest. 2. The aim of this study was to systematically assess the presence of lung abnormalities associated with cardiopulmonary resuscitation- and to evaluate whether mechanical and manual chest compression could play a different role in their development. The hypothesis was tested in a translational study including 1) a porcine model of CA, and 2) a retrospective multicenter observational cohort study of non-traumatic out-of-hospital CA patients with a lung CT scan at hospital admission. 3. This study aimed to investigate the specific pathophysiological role of kynurenine pathway (KP) activation on brain injury and outcomes after CA. We evaluated the effects of genetic deletion of the rate-limiting enzyme of the KP, indoleamine-2,3-dyoxygenase (IDO) on survival and neurological outcome after CA.