NOMI after cardiac arrest. Could refined diagnostics improve outcome?
Research output: Contribution to journal › Debate/Note/Editorial
Intestinal ischaemia is usually classified into acute mesenteric ischaemia (AMI), chronic mesenteric ischaemia and colonic ischaemia. Coeliac, inferior and superior mesenteric arterial/venous emboli/thrombi and non-occlusive mesenteric ischaemia (NOMI) can cause AMI. NOMI pathophysiology involves hypoperfusion, aggravated by bacterial translocation, reperfusion injury, apoptosis and decreased proliferation of enterocytes. NOMI was first reported in 1958 by Ende in three heart failure patients. 1 NOMI is the most lethal form of AMI due to initial mild and nonspecific symptoms that delay diagnosis and treatment. 2 , 3 NOMI is a rare complication. Suspicion of NOMI is vital for early diagnosis, initially depending on the clinical signs of sudden abdominal pain, abdominal distention, peritonitis/muscular guarding, gastrointestinal bleeding and laboratory signs of intestinal ischaemia/multiple organ failure (MOF). Since patients are often ventilated and sedated and/or neurologically compromised after successful cardiopulmonary resuscitation, NOMI is underdiagnosed and potentially life-saving treatment is delayed, 4 which is also true for intensive care patients in general. 5
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