Postarrest Interventions that Save Lives

Steinberg, Alexis; Elmer, Jonathan

doi:10.1016/j.emc.2020.06.001

Cited by 2 publications

(3 citation statements)

References 89 publications

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“…Identifying treatable arrest etiologies is essential because some require immediate interventions (ie, thrombolytics for a massive pulmonary embolism or needle decompression for tension pneumothorax). 22 Clinicians must evaluate whether to initiate urgent treatments such as fluid resuscitation, vasoactive medications, inotropic support, and antiarrhythmic medications. After arrest, patients with ST elevations on ECG require immediate coronary angiography.…”

Section: Prevention Of Rearrestmentioning

confidence: 99%

“…Multiple parallel steps are needed to prevent rearrest and maintain the return of spontaneous circulation. Identifying treatable arrest etiologies is essential because some require immediate interventions (ie, thrombolytics for a massive pulmonary embolism or needle decompression for tension pneumothorax) 22 . Clinicians must evaluate whether to initiate urgent treatments such as fluid resuscitation, vasoactive medications, inotropic support, and antiarrhythmic medications.…”

Section: Pathophysiology and Prevention Of Secondary Brain Injurymentioning

confidence: 99%

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Emergent Management of Hypoxic-Ischemic Brain Injury

Steinberg

2024

CONTINUUM: Lifelong Learning in Neurology

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OBJECTIVE This article outlines interventions used to improve outcomes for patients with hypoxic-ischemic brain injury after cardiac arrest. LATEST DEVELOPMENTS Emergent management of patients after cardiac arrest requires prevention and treatment of primary and secondary brain injury. Primary brain injury is minimized by excellent initial resuscitative efforts. Secondary brain injury prevention requires the detection and correction of many pathophysiologic processes that may develop in the hours to days after the initial arrest. Key physiologic parameters important to secondary brain injury prevention include optimization of mean arterial pressure, cerebral perfusion, oxygenation and ventilation, intracranial pressure, temperature, and cortical hyperexcitability. This article outlines recent data regarding the treatment and prevention of secondary brain injury. Different patients likely benefit from different treatment strategies, so an individualized approach to treatment and prevention of secondary brain injury is advisable. Clinicians must use multimodal sources of data to prognosticate outcomes after cardiac arrest while recognizing that all prognostic tools have shortcomings. ESSENTIAL POINTS Neurologists should be involved in the postarrest care of patients with hypoxic-ischemic brain injury to improve their outcomes. Postarrest care requires nuanced and patient-centered approaches to the prevention and treatment of primary and secondary brain injury and neuroprognostication.

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Section: Prevention Of Rearrestmentioning

confidence: 99%

Section: Pathophysiology and Prevention Of Secondary Brain Injurymentioning

confidence: 99%

Emergent Management of Hypoxic-Ischemic Brain Injury

Steinberg

2024

CONTINUUM: Lifelong Learning in Neurology

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“…Postresuscitation syndrome has particularly severe effects on the brain and the heart, being associated with cerebral ischemia and dysregulation as well as myocardial dysfunction [26]. Sophisticated intensive care is needed to manage postresuscitation syndrome, requiring specialist, multidisciplinary expertise often unavailable at nontertiary hospitals [10,27]. This has led to the observation that standards of care differ across hospitals and that OHCA outcomes may depend on receiving hospital characteristics [28,29 ].…”

Section: Regionalized Care For Out-of-hospital Cardiac Arrestmentioning

confidence: 99%

Cardiac arrest centres: what, who, when, and where?

Yeo

Ong

2022

Current Opinion in Critical Care

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Purpose of reviewCardiac arrest centres (CACs) may play a key role in providing postresuscitation care, thereby improving outcomes in out-of-hospital cardiac arrest (OHCA). There is no consensus on CAC definitions or the optimal CAC transport strategy despite advances in research. This review provides an updated overview of CACs, highlighting evidence gaps and future research directions.Recent findingsCAC definitions vary worldwide but often feature 24/7 percutaneous coronary intervention capability, targeted temperature management, neuroprognostication, intensive care, education, and research within a centralized, high-volume hospital. Significant evidence exists for benefits of CACs related to regionalization. A recent meta-analysis demonstrated clearly improved survival with favourable neurological outcome and survival among patients transported to CACs with conclusions robust to sensitivity analyses. However, scarce data exists regarding ‘who’, ‘when’, and ‘where’ for CAC transport strategies. Evidence for OHCA patients without ST elevation postresuscitation to be transported to CACs remains unclear. Preliminary evidence demonstrated greater benefit from CACs among patients with shockable rhythms. Randomized controlled trials should evaluate specific strategies, such as bypassing nearest hospitals and interhospital transfer.SummaryReal-world study designs evaluating CAC transport strategies are needed. OHCA patients with underlying culprit lesions, such as those with ST-elevation myocardial infarction (STEMI) or initial shockable rhythms, will likely benefit the most from CACs.

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Postarrest Interventions that Save Lives

Cited by 2 publications

References 89 publications

Emergent Management of Hypoxic-Ischemic Brain Injury

Emergent Management of Hypoxic-Ischemic Brain Injury

Cardiac arrest centres: what, who, when, and where?

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