Post-Cardiac Arrest Syndrome

Post Cardiac Arrest Syndrome from Sun YaiCheng

Post-Cardiac Arrest SyndromeEpidemiology, Pathophysiology, Treatment, and Prognostication A Consensus Statement From the International Liaison Committee on Resuscitation Circulation. 2008;118:2452-2483 Background

• CPR→ ROSC→ Resuscitation→ Post-CardiacArrest Syndrome (PCAS)

Epidemiology

• The largest published in-hospital cardiac arrest database (the NRCPR) includes data from > 36000 cardiac arrests.
• In-hospital mortality rate was 67% for the 19,819 adults with any documented ROSC, 62% for the 17,183 adults with ROSC > 20 minutes.

Pathophysiology of Post-Cardiac Arrest Syndrome

• Post-Cardiac Arrest Brain Injury
• Post–Cardiac Arrest Myocardial Dysfunction
• Systemic Ischemia/Reperfusion Response
• Persistent Precipitating Pathology

Therapeutic Strategies

• Monitoring
• Early Hemodynamic Optimization
• Ventilation
• Circulatory Support
• Management of ACS
• Therapeutic Hypothermia
• Sedation and Neuromuscular Blockade
• Seizure Control and Prevention
• Glucose Control
• Placement of Implantable Cardioverter-Defibrillators

Early Goad-Directed Therapy

Management of ACS

• Patients resuscitated from cardiac arrest who have ST-elevation myocardial infarction should undergo immediate coronary angiography, with subsequent PCI if indicated.
• It is appropriate to consider immediate coronary angiography in all post-cardiac arrest patients in whom ACS is suspected.

Therapeutic Hypothermia

• Unconscious adult patients with ROSC after out-of-hospital VF cardiac arrest should be cooled to 32°C to 34°C for at least 12 to 24 hours.
• Rapid IV infusion of ice-cold 0.9% saline or Ringer’s lactate (30 mL/kg) is a simple, effective method for initiating cooling.
• Slow rewarming: 0.25°C to 0.5°C per hour.
• If therapeutic hypothermia is not undertaken, pyrexia during the first 72 hours after cardiac arrest should be treated aggressively with antipyretics or active cooling.

Seizure Control and Prevention

• Prolonged seizures may cause cerebral injury and should be treated promptly and effectively with benzodiazepines, phenytoin, valproate, propofol, or a barbiturate.
• Clonazepam is the drug of choice for the treatment of myoclonus.

Glucose Control

• Tight control blood glucose (80 to 110mg/dL) with insulin.

Placement of Implantable Cardioverter-Defibrillators

• In survivors with good neurological recovery, insertion of an ICD is indicated if subsequent cardiac arrests cannot be reliably prevented by other treatments (such as pacemaker for AV block, transcatheter ablation of a single ectopic pathway, or valve replacement for critical aortic stenosis).

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