delayed reoxygenation and delayed resuscitation

[Mike Smertka]

Hello everyone,
   
  I posed a question about the topic of delayed resuscitation and oxygenation on the EMS-L list and hoped maybe somebody here could answer my questions. 
   
  1. Does effective CPR adequetly perfuse the body enough to stop/reverse anaerobic metabolism in the Brain/kidnetys/heart/liver?
   
  2. What causes an apoptotic rxn when o2 is reindroduced? My only guess is a capsase chain in the mitochondria. Possibly from the others in the cell as well. By I lean towards mitochondria. 
   
  3. Would continued/exteded CPR prior to defib then be more harmful?
   
  I accept that immediate cpr, would perfuse enough heart and brain to stop acidosis there, but what about the liver especially?  
   
  I ask because of a study that was recently announced about possibly delaying defib longer for more cpr. I am very skeptical about that. I know that refractory v-fib is likely from the AHA study if during prolonged downtime the heart is defibed without reoxgenation. But how does all this play out?

       
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