Post‐cardiac arrest intensive care in Sweden: A survey of current clinical practice

Abstract

BackgroundEuropean guidelines recommend targeted temperature management (TTM) in post‐cardiac arrest care. A large multicentre clinical trial, however, showed no difference in mortality and neurological outcome when comparing hypothermia to normothermia with early treatment of fever. The study results were valid given a strict protocol for the assessment of prognosis using defined neurological examinations. With the current range of recommended TTM temperatures, and applicable neurological examinations, procedures may differ between hospitals and the variation of clinical practice in Sweden is not known.AimThe aim of this study was to investigate current practice in post‐resuscitation care after cardiac arrest as to temperature targets and assessment of neurological prognosis in Swedish intensive care units (ICUs).MethodsA structured survey was conducted by telephone or e‐mail in all Levels 2 and 3 (= 53) Swedish ICUs during the spring of 2022 with a secondary survey in April 2023.ResultsFive units were not providing post‐cardiac arrest care and were excluded. The response rate was 43/48 (90%) of the eligible units. Among the responding ICUs, normothermia (36–37.7°C) was applied in all centres (2023). There was a detailed routine for the assessment of neurological prognosis in 38/43 (88%) ICUs. Neurological assessment was applied 72–96 h after return of spontaneous circulation in 32/38 (84%) units. Electroencephalogram and computed tomography and/or magnetic resonance imaging were the most common technical methods available.ConclusionSwedish ICUs use normothermia including early treatment of fever in post‐resuscitation care after cardiac arrest and almost all apply a detailed routine for the assessment of neurological prognosis. However, available methods for prognostic evaluation varies between hospitals.

The capacity of neurological pupil index to predict the absence of somatosensory evoked potentials after cardiac arrest – An observational study

“… 8 However, while pupillometry can be readily available at a low cost, only 53% of Swedish intensive care units (ICU) have access to SSEP for neurologic prognostication. 16 …”