2020 Korean Guidelines for Cardiopulmonary Resuscitation. Part 5. Post-cardiac arrest care

Kim, Young‐Min; Jeung, Kyung Woon; Kim, Won Young; Park, Yoo Seok; Oh, Joo Suk; You, Yeon Ho; Lee, Dong Hoon; Chae, Minjung Kathy; Jeong, Yoseok; Kim, Min Chul; Ha, Eun Jin; Hwang, Kyoung Jin; Kim, Won‐Seok; Lee, Jae-Myung; Cha, Kyoung‐Chul; Park, June Dong; Kim, Han-Suk; Lee, Mi Jin; Na, Sang-Hoon; Kim, Ai-Rhan Ellen; Hwang, Sung Oh

doi:10.15441/ceem.21.025

Cited by 24 publications

(13 citation statements)

References 261 publications

(319 reference statements)

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“…International guidelines for post-CA care recommend a multi-modal approach to predict prognosis [5,6]. However, a combination of various predictors does not unconditionally increase the predictive performance, sensitivity, or specificity [34].…”

Section: Discussionmentioning

confidence: 99%

“…Approximately 19% of patients post-cardiac arrest (CA) die due to early WLST (within three days post-CA), despite a predicted good neurological outcome [2][3][4]. International guidelines for post-CA care recommend that neurological prognostication should be delayed at least 72 h after return of spontaneous circulation (ROSC) [5,6]. Nevertheless, WLST is occasionally performed earlier than 72 h after ROSC due to medical factors, patient values and preferences or premature neurological prognostication related to intensive care unit (ICU) admission and for patients with severe hypoxic ischemic brain injury (HIBI) [3][4][5]7].…”

Section: Introductionmentioning

confidence: 99%

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Association of ultra-early diffusion-weighted magnetic resonance imaging with neurological outcomes after out-of-hospital cardiac arrest

et al. 2023

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Background This study aimed to investigate the association between ultra-early (within 6 h after return of spontaneous circulation [ROSC]) brain diffusion-weighted magnetic resonance imaging (DW-MRI) and neurological outcomes in comatose survivors after out-of-hospital cardiac arrest. Methods We conducted a registry-based observational study from May 2018 to February 2022 at a Chungnam national university hospital in Daejeon, Korea. Presence of high-signal intensity (HSI) (PHSI) was defined as a HSI on DW-MRI with corresponding hypoattenuation on the apparent diffusion coefficient map irrespective of volume after hypoxic ischemic brain injury; absence of HSI was defined as AHSI. The primary outcome was the dichotomized cerebral performance category (CPC) at 6 months, defined as good (CPC 1–2) or poor (CPC 3–5). Results Of the 110 patients (30 women [27.3%]; median (interquartile range [IQR]) age, 58 [38–69] years), 48 (43.6%) had a good neurological outcome, time from ROSC to MRI scan was 2.8 h (IQR 2.0–4.0 h), and the PHSI on DW-MRI was observed in 46 (41.8%) patients. No patients in the PHSI group had a good neurological outcome compared with 48 (75%) patients in the AHSI group. In the AHSI group, cerebrospinal fluid (CSF) neuron-specific enolase (NSE) levels were significantly lower in the group with good neurological outcome compared to the group with poor neurological outcome (20.1 [14.4–30.7] ng/mL vs. 84.3 [32.4–167.0] ng/mL, P < 0.001). The area under the curve for PHSI on DW-MRI was 0.87 (95% confidence interval [CI] 0.80–0.93), and the specificity and sensitivity for predicting a poor neurological outcome were 100% (95% CI 91.2%–100%) and 74.2% (95% CI 62.0–83.5%), respectively. A higher sensitivity was observed when CSF NSE levels were combined (88.7% [95% CI 77.1–95.1%]; 100% specificity). Conclusions In this cohort study, PHSI findings on ultra-early DW-MRI were associated with poor neurological outcomes 6 months following the cardiac arrest. The combined CSF NSE levels showed higher sensitivity at 100% specificity than on DW-MRI alone. Prospective multicenter studies are required to confirm these results.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Association of ultra-early diffusion-weighted magnetic resonance imaging with neurological outcomes after out-of-hospital cardiac arrest

et al. 2023

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“…First, this study was a retrospective, observational, registry-based cohort study performed in a single center, which limited the generalizability of the results and made the presence of unmeasurable confounding bias inevitable. Second, this study included OHCA patients between 2015 and 2021, and the treatment guidelines have been since updated [ 6 , 17 , 18 , 19 , 20 ]. This could affect the clinical decision-making of the physician and, consequently, the outcome for OHCA survivors.…”

Section: Discussionmentioning

confidence: 99%

“…All patients received treatment in accordance with the then-current advanced cardiac life support guidelines [ 6 , 17 , 18 , 19 , 20 ]. During the immediate post-cardiac arrest period, diagnostic studies such as electrocardiography, bedside echocardiography, and computed tomography were performed to identify the cause of OHCA with general intensive care management.…”

Section: Methodsmentioning

confidence: 99%

Ion Shift Index at the Immediate Post-Cardiac Arrest Period as an Early Prognostic Marker in Out-of-Hospital Cardiac Arrest Survivors

Kim

Kwon

Kim

et al. 2022

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The ion shift index (ISI) is a suggested marker to reflect the magnitude of ischemic damage. This study aimed to investigate the prognostic value of the ISI for predicting poor neurological outcomes at 6 months in comatose out-of-hospital cardiac arrest (OHCA) survivors by comparing it with the OHCA and Cardiac Arrest Hospital Prognosis (CAHP) scores. This observational registry-based cohort study included adult comatose OHCA survivors admitted to a tertiary care hospital in Korea between 2015 and 2021. The ISI was calculated using the serum electrolyte levels obtained within one hour of resuscitation. The primary outcome was poor neurological function (Cerebral Performance Category score of 3–5) at 6 months. Of the 250 OHCA survivors, 164 (65.6%) had poor neurological outcomes. These patients had a higher median ISI than those with good neurological outcomes (4.95 vs. 3.26, p < 0.001). ISI (adjusted odds ratio, 2.107; 95% confidence interval, 1.350–3.288, p = 0.001) was associated with poor neurological outcomes. The prognostic performance of ISI (area under the curve [AUC], 0.859) was similar to that of the OHCA score (AUC, 0.858; p = 0.968) and the CAHP score (AUC, 0.894; p = 0.183). ISI would be a prognostic biomarker for comatose OHCA survivors that is available during the immediate post-cardiac arrest period.

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“…However, many critically ill patients are often exposed to malnutrition, which increases their mortality and morbidity [19][20][21][22]. According to the recent American Heart Association, European Cardiopulmonary Resuscitation Association, and the Korean Association of Cardiopulmonary Resuscitation guidelines for post-resuscitation cardiac arrest patients, there are some recommendations for specific nutritional supplement guidelines for these patients [2,23,24].…”

Section: Discussionmentioning

confidence: 99%

Diet-related complications according to the timing of enteral nutrition support in patients who recovered from out-of-hospital cardiac arrest: a propensity score matched analysis

et al. 2022

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Background: A proper nutritional plan for resuscitated patients is important in intensive care; however, specific nutritional guidelines have not yet been established. This study aimed to determine the incidence of diet-related complications that were affected by the timing of enteral nutrition in resuscitated patients after cardiac arrest. Methods: This retrospective and 1:1 propensity score matching study involved patients who recovered after nontraumatic, out-of-hospital cardiac arrest at a tertiary hospital. Patients were divided into an early nutrition support (ENS) group and a delayed nutrition support (DNS) group according to the nutritional support time within 48 hours after admission. The incidence of major clinical complications was compared between the groups. Results: A total of 46 patients (ENS: 23, DNS: 23) were enrolled in the study. There were no differences in body mass index, comorbidity, and time of cardiopulmonary resuscitation between the two groups. There were 9 patients (ENS: 4, DNS: 5) with aspiration pneumonia; 4 patients (ENS: 2, DNS: 2) with regurgitation; 1 patient (ENS: 0, DNS: 1) with ileus; 21 patients (ENS: 10, DNS: 11) with fever; 13 patients (ENS: 8, DNS: 5) with hypoglycemia; and 20 patients (ENS: 11, DNS: 9) with hyperglycemia. The relative risk of each complication during post-resuscitation care was no different between groups. Conclusions: There was a similar incidence of diet-related complications during post cardiac arrest care according to the timing of enteral nutrition.

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2020 Korean Guidelines for Cardiopulmonary Resuscitation. Part 5. Post-cardiac arrest care

Cited by 24 publications

References 261 publications

Association of ultra-early diffusion-weighted magnetic resonance imaging with neurological outcomes after out-of-hospital cardiac arrest

Association of ultra-early diffusion-weighted magnetic resonance imaging with neurological outcomes after out-of-hospital cardiac arrest

Ion Shift Index at the Immediate Post-Cardiac Arrest Period as an Early Prognostic Marker in Out-of-Hospital Cardiac Arrest Survivors

Diet-related complications according to the timing of enteral nutrition support in patients who recovered from out-of-hospital cardiac arrest: a propensity score matched analysis

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