[Cardiopulmonary cerebral resuscitation and acidosis]

It is still controversial whether sodium bicarbonate is effective for the correction of acidemia during cardiopulmonary resuscitation (CPR). To resolve this issue, we must clarify the influence of acidosis accompanied by cardiac arrest on the cardiac and cerebral resuscitability. The influence of acidosis on cardiac resuscitability The factors which determine the cardiac resuscitability during asystole or ventricular fibrillation are the presser response to administered catecholamines and the threshold of defibrillation. However, there is still no evidence that acidosis inhibits these factors during CPR. Recent reports suggested that CO2 itself impaired cardiac resuscitability rather than acidosis. On the other hand, our study using isolated perfused rat hearts proposed that the effect of acidosis is not still eliminated. The influence of acidosis on the cerebral resuscitability There are two contrary opinions. One is that acidosis deteriorates the cerebral damage after resuscitation. The other is that acidosis is rather protective against the cerebral damage. In the studies which support the latter opinion, the evaluation of the effect of reperfusion is lacking. Accordingly, any factors which develop during the reperfusion phase may be enhanced by acidosis. These findings indicate that the influence of acidosis accompanied by cardiac arrest is complicated and that it includes many unresolved questions. Until we clarify these questions, we can not conclude that the correction of acidemia is necessary during CPR.