Ischemic brain protection.

Despite advances in the understanding of the pathophysiology of cerebral ischemia, no single brain resuscitation therapy has yet been shown to be clinically superior to brain-oriented intensive care. Basic concepts in cardiopulmonary-cerebral resuscitation (CPCR) are discussed, as are two specific phases of CPCR, cerebral preservation and cerebral resuscitation. Cerebral preservation is initiated during cardiac arrest (ie, prior to restoration of spontaneous circulation [ROSC]) and includes use of artificial perfusion techniques and drugs to produce cerebral perfusion during this phase. Cerebral resuscitation is brain-oriented therapy initiated after ROSC. Pharmacologic agents currently under study for cerebral resuscitation include the barbiturates, calcium antagonists, and iron chelators. With respect to defining efficacy of the pharmacologic agents, the concept of therapeutic window is important. Although no agent has been proven clinically, several appear to be promising.