Postresuscitative intensive care: neuroprotective strategies after cardiac arrest.
Cardiac arrest is a common disease in the United States, and many patients will die as a result of the neurological damage suffered during the anoxic period, or will live in a neurologically debilitated state. When cardiopulmonary-cerebral resuscitation results in the return of spontaneous circulation, intensive care is required to optimize neurological recovery. Such "brain-oriented" therapies include routine care, such as positioning and maintenance of volume status; optimization of cerebral perfusion, with the use of vasopressors if needed; management of increased intracranial pressure with agents such as hypertonic saline; assuring adequate oxygenation and avoiding hypercapnia; aggressive fever control; intensive glucose control, with the use of an insulin drip if needed; and management of seizures if they occur. To date, no neuroprotectant medications have been shown to improve neurological outcome. Induced moderate therapeutic hypothermia is utilized as a neuroprotective maneuver. Future treatment options and advanced monitoring techniques are also discussed. Further study to optimize neuroprotective strategies when treating patients who survive cardiac arrest is needed.
Wright
Wendy L
WL
Departments of Neurology and Neurosurgery, Emory University Hospital, Atlanta, Georgia, USA.
Geocadin
Romergryko G
RG
D020520:Brain Infarction / Q000209:etiology / Q000517:prevention & control* / Q000628:therapy*; D016887:Cardiopulmonary Resuscitation / Q000592:standards / Q000639:trends; D002560:Cerebrovascular Circulation / Q000187:drug effects / Q000502:physiology; D006323:Heart Arrest / Q000150:complications* / Q000628:therapy; D006801:Humans; D006935:Hypercapnia / Q000503:physiopathology / Q000517:prevention & control / Q000628:therapy; D020925:Hypoxia-Ischemia, Brain / Q000209:etiology / Q000517:prevention & control* / Q000628:therapy*; D007362:Intensive Care Units / Q000592:standards* / Q000639:trends; D019586:Intracranial Hypertension / Q000503:physiopathology / Q000517:prevention & control / Q000628:therapy; D015427:Reperfusion Injury / Q000209:etiology / Q000517:prevention & control / Q000628:therapy; D014662:Vasoconstrictor Agents / Q000627:therapeutic use
D014662:Vasoconstrictor Agents