Haemodynamic and ventilator management in patients following cardiac arrest

Abstract

Purpose of review The purpose of this study is to review the recent literature describing how to assess and treat postcardiac arrest syndrome associated haemodynamics and manage oxygenation and ventilation derangements. Recent findings Postcardiac arrest syndrome is a well described entity that includes systemic ischemia-reperfusion response, myocardial dysfunction and neurologic dysfunction. Continued resuscitation in the hours to days following return of spontaneous circulation (ROSC) is important to increase the likelihood of long-term survival and neurological recovery. Post-ROSC hypotension is common and associated with worse outcome. Myocardial dysfunction peaks in the first 24 h following ROSC and in survivors resolves over the next few days. Hyperoxemia (paO2 >300 mmHg) and hypoxemia (paO2 <60 mmHg) are associated with worse outcomes and hyperventilation may exacerbate cerebral ischemic injury by decreasing cerebral oxygenation. Summary Patients who are successfully resuscitated from cardiac arrest often have hypotension and myocardial dysfunction. Careful attention to haemodynamic and ventilator management targeting normal blood pressure, normoxemia and normocapnia may help to avoid secondary organ injury and potentially improve outcomes.

Risk factors for and prediction of post-intubation hypotension in critically ill adults: A multicenter prospective cohort study

“…In our study, patients who suffered a cardiac arrest but had a perfusing rhythm at the time of ETI were included. Peri-cardiac arrest hypotension due to myocardial dysfunction is common and leads to poor outcomes [28,29]. In addition, data from Get-With-The-Guidelines registry has demonstrated that hypotension surrounding an acute respiratory compromise event is frequently associated with cardiac arrest [30].…”

Post-cardiac arrest care in the intensive care unit

“…46 The ideal blood pressure target after cardiac arrest is uncertain, but hypotension after ROSC is clearly associated with worse outcomes. 42 The 2020 AHA guidelines recommended individualized systolic blood pressure and MAP goals given the many factors to consider post-cardiac arrest. 47 However, rapidly restoring MAP > 65 mm Hg or systolic blood pressure > 90 mm Hg is recommended given that MAPs <65 mm Hg are associated with impaired cerebral oximetry and poor outcomes.…”

Mechanical Ventilation Management During Mechanical Chest Compressions

“…However, how hyper-and hypoxemia affect survival and neurological outcomes is controversial. 32,33,42 A recent meta-analysis, which pooled the data of the only 2 clinical studies present in the literature, 34,35 concluded that whereas hyperoxemia in the postarrest period is associated with a worse outcome, during CPR it appears to be related to a higher rate of return of spontaneous circulation. 36 The effects induced by hyperoxemia seem to correlate with the timing of the pathological process, rather than a simple on/off effect.…”