Post-resuscitation care: current therapeutic concepts.
Post-resuscitation care is coming increasingly into focus. The patient with a return in spontaneous circulation (ROSC) often presents with a post-arrest 'sepsis-like syndrome', which requires a multidisciplinary implementation of timely reperfusion, proper inotropic support and monitoring, glucose control, therapeutic hypothermia, and adequate sedation in the intensive care unit (ICU). Low tidal volume (6 ml/kg) ventilation is preferred, and the standard vasopressor treatment of dobutamine, dopamine, and norepinephrine can be used to improve the patient's haemodynamic profile. Coronary revascularization should be attempted where there is evidence of ST-segment elevation myocardial infarction (STEMI), even in comatose patients. The recently published TROICA trial did not prove that thrombolysis improved survival. Glycaemic management can help decrease the length and cost of ICU stay, although the argument for tight glucose control has been recently challenged. Therapeutic hypothermia should be aggressively implemented in comatose adult patients after arrest from a shockable rhythm. Seizures are associated with a worse neurological outcome and early anti-convulsant prevention is advocated. Raised biomarkers such as NSE and S-100 beta may correlate with neurological outcome, but also overestimate the extent of cerebral damage in resuscitated patients and have a wide confidence interval. Simple neurological examination manoeuvers strongly predict death or poor outcome.
Cokkinos
Philip
P
2nd Cardiology Department, Onassis Cardiac Surgery Center, Athens, Greece. philipcokkinos@yahoo.com
D001786:Blood Glucose / Q000187:drug effects / Q000378:metabolism; D016887:Cardiopulmonary Resuscitation / Q000379:methods*; D003325:Coronary Care Units; D004831:Epilepsies, Myoclonic / Q000209:etiology / Q000628:therapy; D006323:Heart Arrest / Q000188:drug therapy / Q000628:therapy*; D006801:Humans; D007036:Hypothermia, Induced; D008991:Monitoring, Physiologic; D009204:Myocardial Revascularization / Q000379:methods; D009460:Neurologic Examination / Q000379:methods; D013577:Syndrome; D015912:Thrombolytic Therapy
D001786:Blood Glucose