Inhaled anaesthesia compared with conventional sedation in post cardiac arrest patients undergoing temperature control: A systematic review and meta-analysis

Parlow, Simon; Lepage-Ratte, Melissa Fay; Jung, Richard G.; Fernando, Shannon M.; Visintini, Sarah; Sterling, Lee H.; Santo, Pietro Di; Simard, Trevor; Russo, Juan; Labinaz, Marino; Hibbert, Benjamin; Nolan, Jerry P.; Rochwerg, Bram; Mathew, Rebecca

doi:10.1016/j.resuscitation.2022.05.015

Cited by 6 publications

(1 citation statement)

References 41 publications

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“…Nevertheless, it is essential to acknowledge that sedatives like propofol can potentially lead to compromised circulatory function and significant alterations in brain function, as indicated by burst-suppression patterns observed on EEG monitoring [58]. The potential advantages, including faster awakening, fewer adverse effects, and fewer neuromonitoring alterations, of alternative drugs such as dexmedetomidine [59] or inhaled anesthetics warrant investigation in larger-scale studies [60]. Additionally, the suitability of utilizing EEG to guide the depth of anesthesia in these patients remains unclear, given that certain EEG patterns may be linked to the severity of anoxic injury rather than the specific sedative administered.…”

Section: General Intensive Carementioning

confidence: 99%

Postresuscitation management

Behringer,

Skrifvars,

Taccone

2023

Current Opinion in Critical Care

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Purpose of review To describe the most recent scientific evidence on ventilation/oxygenation, circulation, temperature control, general intensive care, and prognostication after successful resuscitation from adult cardiac arrest. Recent findings Targeting a lower oxygen target (90–94%) is associated with adverse outcome. Targeting mild hypercapnia is not associated with improved functional outcomes or survival. There is no compelling evidence supporting improved outcomes associated with a higher mean arterial pressure target compared to a target of >65 mmHg. Noradrenalin seems to be the preferred vasopressor. A low cardiac index is common over the first 24 h but aggressive fluid loading and the use of inotropes are not associated with improved outcome. Several meta-analyses of randomized clinical trials show conflicting results whether hypothermia in the 32–34°C range as compared to normothermia or no temperature control improves functional outcome. The role of sedation is currently under evaluation. Observational studies suggest that the use of neuromuscular blockade may be associated with improved survival and functional outcome. Prophylactic antibiotic does not impact on outcome. No single predictor is entirely accurate to determine neurological prognosis. The presence of at least two predictors of severe neurological injury indicates that an unfavorable neurological outcome is very likely. Summary Postresuscitation care aims for normoxemia, normocapnia, and normotension. The optimal target core temperature remains a matter of debate, whether to implement temperature management within the 32–34°C range or focus on fever prevention, as recommended in the latest European Resuscitation Council/European Society of Intensive Care Medicine guidelines Prognostication of neurological outcome demands a multimodal approach.

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Section: General Intensive Carementioning

confidence: 99%