ISCHAEMIA-REPERFUSION INJURY TO THE GUT FOLLOWING CARDIOPULMONARY RESUSCITATION

Abstract

Ischaemia-reperfusion injury (IRI) to the gut following cardiopulmonary resuscitation (CPR) gives rise to
local effects including altered mucosal permeability and infarction of the gut, and remote consequences
which may culminate in multiple organ failure with a potentially fatal outcome. We describe two cases of
IRI to the gut following CPR in patients where diarrhoea and abdominal pain in the first, and haematemesis,
rectal bleeding and peritonitis in the second patient were the presenting features. The relevant aspects of
pathophysiology and management are summarised.
IRI to the gut, defined as tissue damage occurring as a direct consequence of revascularisation, results from
intestinal hypoperfusion due to cardiogenic, septic, or haemorrhagic shock, the use of vasoactive drugs,
supra-coeliac aortic cross-clamping, construction of free intestinal grafts, or a mesenteric embolic event.
We describe two cases of IRI to the gut following CPR and summarise the relevant aspects of its
pathophysiology and management.
Key Words: Ischaemia-reperfusion injury, gut, cardiopulmonary resuscitation.