Reanimation research

Three fourths of patients who suffer from cardiac arrest die even though advances in emergency medicine have made it possible to introduce the first reanimation measures long before irreversible organ damage starts. Wide-ranging basic research is absolutely necessary. The Max Planck Society is striving for multidisciplinary reanimation research.

Reanimation involves the resuscitation of body organs after circulatory collapse. The organ that limits successful reanimation of organisms after cardiac arrest is the brain, which is irreversibly damaged after a few minutes without treatment. Other body organs can be reanimated after considerably longer circulatory collapses, as shown by the success of transplantation medicine.

The high sensitivity of the brain is not based on the especially quick death of nerve cells during a circulatory collapse, as was previously assumed, but rather on the fact that delayed haemodynamic and molecular disorders which contribute to secondary cell death arise after reanimation has started. Our current level of research makes it possible to minimize these disorders under stringent experimental conditions. It has been possible to reanimate the metabolism and the function of nerve cell clusters and, in isolated cases, to restore integrative neurological activities after an hour of circulatory collapse at normal body temperature. The implementation of this knowledge in the reanimation of the entire organism after cardiac arrest failed, however, because the brain and all other body organs are affected by cardiac arrest. The complex interaction of the functional disorders of these organs prevents a coordinated restoration of the organism’s overall function. Decisive progress in reanimation research can therefore be expected only if the problem of cardiac arrest is pursued through multidisciplinary coordination on the basis of organ pathophysiology. Research of this kind is extraordinarily expensive because of the complex methodical approaches and requisite equipment expenditures. It has therefore been undertaken by only a few institutions worldwide.

The necessity of wide-ranging basic research in the field of reanimation is apparent. Three- fourths of patients suffering from cardiac arrest die despite advances in emergency medicine – at least in conurbations – which have allowed reanimation measures to be taken long before irreversible organ damage has set in. Reanimation research also benefits several other current research topics. Examples include the mechanisms of organ regeneration, multiorgan damage, and apoptotic cell death. The molecular consequences of interrupted oxygen supply and the degree to which they can be influenced by therapy and blood vessel interactions, which explain reperfusion disorder mechanisms, are of great scientific interest. Some of these topics are already being addressed on the cellular level at several Max Planck Institutes, but their relevance to systemic disease processes can be researched only with corresponding multiorgan systems. The development of multidisciplinary reanimation research would provide expertise regarding the entire organism, which would be of overall benefit to disease research within the Biology and Medicine Section.