TY - JOUR

T1 - Haemodynamic, oxygenation, and ventilation targets after cardiac arrest

T2 - the current ABC of post-cardiac arrest intensive care

AU - Kjaergaard, Jesper

AU - Møller, Jacob Eifer

PY - 2023

Y1 - 2023

N2 - Patients remaining in coma after having been resuscitated from out-of-hospital cardiac arrest (OHCA) frequently require intensive care. These patients are usually managed by a guideline-recommended, goal-directed approach to support and maintain organ function.1 Since hypoxic brain injury is the leading cause of death in these patients,2 neuroprotective strategies and interventions have been implemented and investigated. In fact, post-resuscitation care has come to represent a bundle of strategies and goal-directed interventions administered over the first 2–5 days following cardiac arrest.1While research in post-cardiac arrest care of OHCA patients has been dominated by targeted temperature management (TTM) and neurological prognostication,1 the other aspects of optimizing therapy have received less scientific attention. Targeted temperature management was originally implemented after two randomized clinical trials were published in 2002, reporting the clinical benefits of lowering body temperature to 33°C for 12–24 h.3,4 These trials were unspecific in terms of guiding the other aspects of post-cardiac arrest care in the intensive care setting. Later trials in TTM have been pragmatic, and the results have questioned the benefits of mild-to-moderate hypothermia in the immediate post-resuscitation phase.5,6Although ischaemic heart disease is the underlying cause of cardiac arrest in many OHCA patients , an initial diagnostic approach of immediate coronary angiography in patients suspected with an acute myocardial infarction ST segment myocardial infarction has also been challenged.7Therefore, contemporary patient management is largely based on intensive supportive care and most centres have standardized protocols for supporting airway, breathing, and circulation for patients remaining in coma after cardiac arrest. Both American and European guidelines have provided recommendations on treatment targets in post-resuscitation care but have made it clear that evidence is less.1,8This review seeks to provide an overview of current evidence and guidelines on goals for intensive care for the initial days of post-cardiac arrest. Table 1 provides an overview of the recent randomized trials conducted.

AB - Patients remaining in coma after having been resuscitated from out-of-hospital cardiac arrest (OHCA) frequently require intensive care. These patients are usually managed by a guideline-recommended, goal-directed approach to support and maintain organ function.1 Since hypoxic brain injury is the leading cause of death in these patients,2 neuroprotective strategies and interventions have been implemented and investigated. In fact, post-resuscitation care has come to represent a bundle of strategies and goal-directed interventions administered over the first 2–5 days following cardiac arrest.1While research in post-cardiac arrest care of OHCA patients has been dominated by targeted temperature management (TTM) and neurological prognostication,1 the other aspects of optimizing therapy have received less scientific attention. Targeted temperature management was originally implemented after two randomized clinical trials were published in 2002, reporting the clinical benefits of lowering body temperature to 33°C for 12–24 h.3,4 These trials were unspecific in terms of guiding the other aspects of post-cardiac arrest care in the intensive care setting. Later trials in TTM have been pragmatic, and the results have questioned the benefits of mild-to-moderate hypothermia in the immediate post-resuscitation phase.5,6Although ischaemic heart disease is the underlying cause of cardiac arrest in many OHCA patients , an initial diagnostic approach of immediate coronary angiography in patients suspected with an acute myocardial infarction ST segment myocardial infarction has also been challenged.7Therefore, contemporary patient management is largely based on intensive supportive care and most centres have standardized protocols for supporting airway, breathing, and circulation for patients remaining in coma after cardiac arrest. Both American and European guidelines have provided recommendations on treatment targets in post-resuscitation care but have made it clear that evidence is less.1,8This review seeks to provide an overview of current evidence and guidelines on goals for intensive care for the initial days of post-cardiac arrest. Table 1 provides an overview of the recent randomized trials conducted.

U2 - 10.1093/ehjacc/zuad077

DO - 10.1093/ehjacc/zuad077

M3 - Review

C2 - 37459572

AN - SCOPUS:85170205990

VL - 12

SP - 513

EP - 517

JO - European Heart Journal: Acute Cardiovascular Care

JF - European Heart Journal: Acute Cardiovascular Care

SN - 2048-8726

IS - 8

ER -