Hypoxic ischaemic brain injury

Hypoxiceischaemic brain injury (HIBI) is the main cause of prolonged or permanent neurological impairment and poor neurological outcomes in patients post-cardiac arrest (CA). CA causes an extensive brain injury of variable degree whose outcomes vary from complete recovery to severe disability or death. After the initial ischaemia, reperfusion injury evolves over time and may result in neuronal membrane instability, brain oedema, intracranial hypertension, brain hypoperfusion and reduced autoregulation. Understanding the underlying mechanisms could help in the development of targeted treatments, further neuroprotective measures and ultimately better neurological outcomes. The care of CA patients with HIBI is not only clinically challenging but it also involves ethical and legal aspects. Changes in the post-resuscitation care guidelines focus on identification and treatment of the underlying cause of cardiac arrest as well as an emphasis on the rehabilitation process post-HIBI. In this article we aim to outline the pathophysiology of HIBI as well as the most recent developments on targeted treatments. It is crucial to accurately assess prognosis and to assess the probability to recover neurologically; a series of prognostication tools are available to the clinician and a multimodal approach increases accuracy of decision-making process. We summarize the prognostication tools available, highlighting their particularities. Ongoing research aims to create targeted treatments and improve prognostication tools