Manejo del síndrome posparada cardíaca

Abstract

Since the advent of cardiopulmonary resuscitation more than 40 years ago, we have achieved a return to spontaneous circulation in a growing proportion of patients with cardiac arrest. Nevertheless, most of these patients die in the first few days after admission to the intensive care unit (ICU), and this situation has not improved over the years. Mortality in these patients is mainly associated to brain damage. Perhaps recognizing that cardiopulmonary resuscitation does not end with the return of spontaneous circulation but rather with the return of normal brain function and total stabilization of the patient would help improve the therapeutic management of these patients in the ICU. In this sense, the term cardiocerebral resuscitation proposed by some authors might be more appropriate. The International Liaison Committee on Resuscitation recently published a consensus document on the "Post-Cardiac Arrest Syndrome" and diverse authors have proposed that post-arrest care be integrated as the fifth link in the survival chain, after early warning, early cardiopulmonary resuscitation by witnesses, early defibrillation, and early advanced life support. The therapeutic management of patients that recover spontaneous circulation after cardiopulmonary resuscitation maneuvers based on life support measures and a series of improvised actions based on "clinical judgment" might not be the best way to treat patients with post-cardiac arrest syndrome. Recent studies indicate that using goal-guided protocols to manage these patients including therapeutic measures of proven efficacy, such as inducing mild therapeutic hypothermia and early revascularization, when indicated, can improve the prognosis considerably in these patients. Given that there is no current protocol based on universally accepted evidence, the Steering Committee of the National Cardiopulmonary Resuscitation Plan of the Spanish Society of Intensive Medicine and Cardiac Units has elaborated this document after a thorough review of the literature and an online discussion involving all the members of the committee and a consensus meeting with the aim of providing a platform for the development of local protocols in different ICSs in our country to fit their own means and characteristics.

The Post-Resuscitative Urinalysis Associate the Survival of Patients with Non-Traumatic Out-of-Hospital Cardiac Arrest

“…[2], [3], [7], [10], [12], [25] Moreover, certain clinical biomarkers, such as iohexol clearance, cystatin C, and β-trace protein, have been demonstrated to reflect kidney functions early. The determination of the plasma clearance of iohexol is a simple, rapid, and accurate method that can be used to estimate the glomerular filtration rate (GFR) in critical patients.…”

Reanimación cardiocerebral intrahospitalaria

“…No se debe priorizar la intubació n orotraqueal de estos pacientes, pudiendo usarse ventilació n manual con ambú conectado a toma de oxígeno o incluso mascarillas de alto flujo 14 . 3) Cuidados posresucitació n y síndrome posparada 17 . Entidad clínica que se produce a consecuencia de la aplicació n de maniobras de RCP una vez conseguida la recuperació n de la circulació n espontá nea.…”

“…En el estudio de Aufderheide et al ya se hace menció n a este factor y se recomienda una frecuencia ventilatoria entre 12 y 15 por minuto, en lugar de las clá sicas 30 ventilaciones por minuto 38 . La tercera fase se denomina fase metabó lica, donde existen numerosos mecanismos de lesió n celular mediada por la hipoxia y generació n de radicales libres, siendo en esta fase donde má s protagonismo tiene la inducció n de hipotermia y el síndrome posparada 17 .…”

Novedades en soporte vital avanzado

“…Es importante reconocer que el tratamiento que reciben durante este periodo posresucitación influye significativamente en el pronóstico neurológico final [47][48][49] . La fase posresucitación comienza en el lugar donde se consigue la RCE pero, una vez estabilizado, el paciente debe ser transferido a un área de cuidados intensivos, para monitorización continua y tratamiento.…”