Postresuscitation Care after Out-of-hospital Cardiac Arrest: Clinical Update and Focus on Targeted Temperature Management

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  • Hans Kirkegaard
  • Fabio Silvio Taccone, Univ Libre Bruxelles, Universite Libre de Bruxelles, Clin Univ Bruxelles Erasme, Dept Intens Care
  • ,
  • Markus Skrifvars, Univ Helsinki, University of Helsinki, Helsinki Coll Adv Studies
  • ,
  • Eldar Soreide, Univ Bergen, University of Bergen, Dept Clin Med, Inst Med & Dent, Stavanger University Hospital, Stavanger

Out-of-hospital cardiac arrest is a major cause of mortality and morbidity worldwide. With the introduction of targeted temperature management more than a decade ago, postresuscitation care has attracted increased attention. In the present review, we discuss best practice hospital management of unconscious out-of-hospital cardiac arrest patients with a special focus on targeted temperature management. What is termed post-cardiac arrest syndrome strikes all organs and mandates access to specialized intensive care. All patients need a secured airway, and most patients need hemodynamic support with fluids and/or vasopressors. Furthermore, immediate coronary angiography and percutaneous coronary intervention, when indicated, has become an essential part of the postresuscitation treatment. Targeted temperature management with controlled sedation and mechanical ventilation is the most important neuroprotective strategy to take. Targeted temperature management should be initiated as quickly as possible, and according to international guidelines, it should be maintained at 32 degrees to 36 degrees C for at least 24 h, whereas rewarming should not increase more than 0.5 degrees C per hour. However, uncertainty remains regarding targeted temperature management components, warranting further research into the optimal cooling rate, target temperature, duration of cooling, and the rewarming rate. Moreover, targeted temperature management is linked to some adverse effects. The risk of infection and bleeding is moderately increased, as is the risk of hypokalemia and magnesemia. Circulation needs to be monitored invasively and any deviances corrected in a timely fashion. Outcome prediction in the individual patient is challenging, and a self-fulfilling prophecy poses a real threat to early prognostication based on clinical assessment alone. Therefore, delayed and multimodal prognostication is now considered a key element of postresuscitation care. Finally, modern postresuscitation care can produce good outcomes in the majority of patients but requires major diagnostic and therapeutic resources and specific training. Hence, recent international guidelines strongly recommend the implementation of regional prehospital resuscitation systems with integrated and specialized cardiac arrest centers.

Original languageEnglish
JournalAnesthesiology
Volume131
Issue1
Pages (from-to)186-208
Number of pages23
ISSN0003-3022
DOIs
Publication statusPublished - Jul 2019

    Research areas

  • TARGETED TEMPERATURE MANAGEMENT, MILD THERAPEUTIC HYPOTHERMIA, CRITICALLY-ILL PATIENTS, POSTANOXIC STATUS EPILEPTICUS, SUCCESSFUL CARDIOPULMONARY-RESUSCITATION, PERCUTANEOUS CORONARY INTERVENTION, INTERNATIONAL LIAISON COMMITTEE, NEURON-SPECIFIC ENOLASE, EARLY ENTERAL NUTRITION, SERUM POTASSIUM LEVELS

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