Scope of the Problem

The problem of cerebral resuscitation is one of tremendous scope for (at least) two reasons:

The problem is incredibly complex. As you will see, neuronal death after an ischemic insult is a hideously complicated phenomenon, involving many damaging processes. These damaging processes are highly interlocked, to the point where isolating the effects of one process to the exclusion of others is almost impossible. The study of ischemic brain damage boils down to the science of what happens when the most complex object in the known universe gets sick.

The problem involves incalculable human suffering and huge costs to society. Stroke effects up to 700,000 people a year in the US alone, and 70,000 a year survive a cardiac arrest, most with significant brain damage. The costs for stroke alone approach $60 billion.

It is my personal and somewhat biased opinion that cerebral resuscitation is a problem of unsurpassed importance for the emergency physician. The modern emergency physician has an unprecedented ability to revive the arrested heart, and stabilize patients with shock and head trauma, and there's every reason to believe we'll continue to make progress in resuscitology -- slow, painfully slow -- but steady. What good, though, is a resuscitologist when his/her ministrations only increase the number of human vegetables? We need a clinically effective approach to brain preservation, as physicians and as a specialty.