Cardiac resuscitation and coagulation.

1009 April 2014 C ARDIAC arrest occurs with an estimated annual incidence of 92 to 189 cases per 100,000 individuals and carries a poor prognosis despite advances in modern medicine.1 Even for patients in whom spontaneous circulation is restored, their subsequent hospital course is fraught with potential complications. Derangements in the coagulation and fibrinolytic systems frequently occur as a result of cardiac arrest and cardiopulmonary resuscitation (CPR). These changes play a significant role in the spectrum of conditions classified as “post–cardiac arrest syndrome.”2 In addition to the endogenous changes in blood coagulation after cardiac arrest, iatrogenic coagulopathies can be seen at various time points as ancillary effects of certain treatment options for these patients (fig. 1). In this article, we review the changes in the coagulation systems of patients experiencing cardiac arrest and CPR and further discuss coagulopathies potentially associated with hypothermia, thrombolysis, and extracorporeal membrane oxygenation (ECMO) therapy.