{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T16:50:55Z","timestamp":1786121455146,"version":"build-2736575974"},"reference-count":71,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T00:00:00Z","timestamp":1786060800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Microbiol."],"abstract":"<jats:p>Post-cardiac arrest syndrome (PCAS) is a complex pathophysiological condition triggered by systemic ischemia\u2013reperfusion injury following cardiac arrest and is frequently associated with multi-organ dysfunction and poor neurological outcomes. Emerging evidence suggests that the gut microbiota, increasingly recognized as a key regulator of host immunity, metabolism, and intestinal barrier integrity, may participate in the pathogenesis and progression of PCAS. Alterations in microbial composition and function following cardiac arrest have been associated with systemic inflammation, immune dysregulation, impaired intestinal barrier function, and gut\u2013brain axis\u2013mediated neurological injury. This narrative review summarizes current evidence regarding gut microbiota alterations after cardiac arrest and discusses their potential mechanistic links with PCAS progression. We further review emerging associations between microbial signatures and clinical outcomes and explore microbiota-targeted therapeutic approaches, including probiotics, prebiotics, and other microecological interventions. Given that direct evidence in PCAS remains limited, mechanistic insights derived from related critical illnesses are also discussed where biologically relevant. A better understanding of host\u2013microbiota interactions may facilitate the identification of novel biomarkers and therapeutic targets and support the development of adjunctive strategies to improve outcomes after cardiac arrest.<\/jats:p>","DOI":"10.3389\/fmicb.2026.1893259","type":"journal-article","created":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T05:29:07Z","timestamp":1786080547000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Gut microbiota dysbiosis in post-cardiac arrest syndrome: mechanisms, clinical implications, and therapeutic perspectives"],"prefix":"10.3389","volume":"17","author":[{"given":"Rui","family":"Liu","sequence":"first","affiliation":[{"name":"Department of Emergency Medicine, The Second Affiliated Hospital of Zhejiang Chinese Medical University","place":["Hangzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Junlong","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Urology, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine)","place":["Hangzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,8,7]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"562","DOI":"10.1161\/01.CIR.0000023891.80661.AD","article-title":"Successful cardiopulmonary resuscitation after cardiac arrest as a \u201csepsis-like\u201d syndrome","volume":"106","author":"Adrie","year":"2002","journal-title":"Circulation"},{"key":"B2","doi-asserted-by":"publisher","first-page":"783","DOI":"10.1016\/j.cell.2006.02.015","article-title":"Pathogen recognition and innate immunity","volume":"124","author":"Akira","year":"2006","journal-title":"Cell"},{"key":"B3","doi-asserted-by":"publisher","first-page":"420","DOI":"10.1016\/S0140-6736(19)31266-8","article-title":"The evolution of the use of faecal microbiota transplantation and emerging therapeutic indications","volume":"394","author":"Allegretti","year":"2019","journal-title":"Lancet"},{"key":"B4","doi-asserted-by":"publisher","first-page":"751","DOI":"10.1007\/s15010-018-1178-5","article-title":"Gut-origin sepsis in the critically ill patient: pathophysiology and treatment","volume":"46","author":"Assimakopoulos","year":"2018","journal-title":"Infection"},{"key":"B5","doi-asserted-by":"publisher","first-page":"516","DOI":"10.1038\/nm.4068","article-title":"Commensal microbiota affects ischemic stroke outcome by regulating intestinal \u03b3\u03b4 T cells","volume":"22","author":"Benakis","year":"2016","journal-title":"Nat. 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