title: Out-of-Hospital Cardiac Arrest and Acute Coronary Syndromes: Reviewing Post-Resuscitation Care Strategies.
abstract: Out-of-hospital cardiac arrest (OHCA) carries an enormous global burden of mortality and morbidity. The post-cardiac arrest syndrome consists of complex pathophysiological changes that result in hypoxic brain injury, myocardial and peripheral organ dysfunction, and the systemic ischemia-reperfusion response. We review common cardiac arrest cases to highlight key management issues and recommendations in post-resuscitation care, including therapeutic hypothermia, coronary angiography and revascularization, and circulatory support. Guidelines still suggest mild therapeutic hypothermia be administered for OHCA over targeted temperature management preventing pyrexia. Similarly, early invasive coronary angiography is particularly beneficial when there is ST-elevation on the post-resuscitation electrocardiogram, but might be considered in the absence of ST-elevation if there is no noncardiac cause to explain the OHCA. However, there remain a large number of unanswered questions that require ongoing research.
authors.affiliation: Division of Cardiology, Department of Medicine, London Health Sciences Centre, Western University, London, Ontario, Canada.
authors.forename: Varinder K
authors.initials: VK
authors.lastname: Randhawa
authors.affiliation: Division of Cardiac Surgery, Department of Surgery, London Health Sciences Centre, Western University, London, Ontario, Canada; Critical Care Western, Department of Medicine, London Health Sciences Centre, Western University, London, Ontario, Canada.
authors.forename: A Dave
authors.initials: AD
authors.lastname: Nagpal
authors.affiliation: Division of Cardiology, Department of Medicine, London Health Sciences Centre, Western University, London, Ontario, Canada. Electronic address: shahar.lavi@lhsc.on.ca.
authors.forename: Shahar
authors.initials: S
authors.lastname: Lavi
mesh_terms: D054058:Acute Coronary Syndrome / Q000150:complications / Q000401:mortality / Q000628:therapy*; D000328:Adult; D000368:Aged; D000465:Algorithms; D003131:Combined Modality Therapy; D017023:Coronary Angiography; D004562:Electrocardiography; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D007036:Hypothermia, Induced; D009204:Myocardial Revascularization; D058687:Out-of-Hospital Cardiac Arrest / Q000150:complications / Q000401:mortality / Q000628:therapy*; D012151:Resuscitation; D015996:Survival Rate