Post-resuscitation care - 2023
The return of spontaneous circulation is only the first step towards recovery after cardiac arrest. Based on prolonged hypoperfusion leading to organ ischemia and subsequent reperfusion, various pathophysiological processes develop, significantly influencing the patient's prognosis in intensive care. It is important to remember that the outcome can be favorable or inauspicious, hence the necessity to consider both scenarios. For this reason, the algorithm includes the option to choose between a positive and unfavorable prognosis. The algorithm will guide you through current post-resuscitation care recommendations, from causal therapy for circulatory arrest to recommended patient temperature management and neuroprognostic examinations. Because the saying states: 'Life is the brain.'
Review
Post-resuscitation care and its quality are crucial factors that affect the outcome of patients after circulatory arrest. Although the current joint recommendations of the ERC and ESICM cover most of these aspects, they are often not consistently applied in practice. This inconsistency is mainly due to the lack of access to instrumental patient prognostication and TTM management methods. The interactive algorithm presented is well-structured and fully meets these recommendations. I particularly value the recognition of epileptic activity as a common complication and the practical approach to its management. The procedure for patients with poor neurological outcomes is also effectively addressed.
Sources
Nolan, J. P., Sandroni, C., Böttiger, B. W., Cariou, A., Cronberg, T., Friberg, H., Genbrugge, C., Haywood, K., Lilja, G., Moulaert, V. R. M., Nikolaou, N., Mariero Olasveengen, T., Skrifvars, M. B., Taccone, F., & Soar, J. (2021). European Resuscitation Council and European Society of Intensive Care Medicine Guidelines 2021: Post-resuscitation care. Resuscitation, 161, 220–269. Available at: http://doi.org/10.1016/j.resuscitation.2021.02.012
Sandroni, C., Nolan, J.P., Andersen, L.W. et al. ERC-ESICM guidelines on temperature control after cardiac arrest in adults. Intensive Care Med 48, 261–269 (2022). Available at: https://doi.org/10.1007/s00134-022-06620-5
Konstantinides SV, Meyer G, Becattini C, et al. 2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS). Eur Respir J. 2019; 54(3): p. 1901647. Available at: https://dx.doi.org/10.1183/13993003.01647-2019
Co I, Eilbert W, Chiganos T. New Electrocardiographic Changes in Patients Diagnosed with Pulmonary Embolism. J Emerg Med. 2017; 52(3): pp. 280–285. Available at: https://dx.doi.org/10.1016/j.jemermed.2016.09.009
Rokyta, R., Hutyra, M., & Jansa, P. (2020). Doporučené postupy Evropské Kardiologické Společnosti (ESC) pro Diagnostiku A Léčbu Akutní plicní embolie, Verze 2019.Stručný přehled Vypracovaný českou Kardiologickou Společností. Cor et Vasa, 62(2), 154–182. Available at: https://doi.org/10.33678/cor.2020.016
Glauser T, Shinnar S, Gloss D, et al. Evidence-Based Guideline: Treatment of Convulsive Status Epilepticus in Children and Adults: Report of the Guideline Committee of the American Epilepsy Society. Epilepsy Currents. 2016; 16(1): pp. 48–61. Available at: https://doi.org/10.5698/1535-7597-16.1.48
Learning targets
2. The algorithm solver can set physiological function goals during post-resuscitation care
3. The algorithm solver will schedule the prognostication of the neurological condition at the right time.
Key points
2. The time elapsed since spontaneous circulation is restored plays a crucial role in determining the prognosis of the patient in the intensive care unit.
3. Neuroprognostication involves a multimodal approach (including ocular reflexes, SSEP, EEG, neuronal laboratory markers, CT/MRI). When at least 2 of these neuroprognostic markers indicate irreversible damage, a poor prognosis is pronounced.
