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Postresuscitation care and prognostication
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Nolan, Jerry P. and Abella, Benjamin S. (2021) Postresuscitation care and prognostication. Current Opinion in Critical Care, 27 (6). pp. 649-655. doi:10.1097/MCC.0000000000000877 ISSN 1070-5295.
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Official URL: https://doi.org/10.1097/MCC.0000000000000877
Abstract
Purpose of review:
Most patients who are successfully resuscitated after cardiac arrest are initially comatose and require mechanical ventilation and other organ support in an ICU. Knowledge about the optimal strategy for treating these patients is evolving rapidly. This review will summarize the evidence on key aspects of postarrest care and prognostication, with a focus on actionable parameters that may impact patient survival and neurologic outcomes.
Recent findings:
Optimal targets for arterial blood oxygen and carbon dioxide in comatose postcardiac arrest patients remain uncertain. Observational data are conflicting and the few randomized controlled trials to date have failed to show that different ranges of blood oxygen and carbon dioxide values impact on biomarkers of neurological injury. The Targeted Temperature Management 2 (TTM-2) trial has documented no difference in 6-month mortality among comatose postcardiac arrest patients managed at 33 oC versus controlled normothermia. An extensive systematic review of the evidence on prognostication of outcome among comatose postcardiac arrest patients underpins new prognostication guidelines.
Summary:
Clinical guidelines for postresuscitation care have recently been updated and incorporate all the available science supporting the treatment of postcardiac arrests. At a minimum, fever should be strictly avoided in comatose postcardiac patients. Prognostication must involve multiple modalities and should not be attempted until assessment confounders have been sufficiently excluded.
| Item Type: | Journal Article | ||||||
|---|---|---|---|---|---|---|---|
| Divisions: | Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Clinical Trials Unit Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School |
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| SWORD Depositor: | Library Publications Router | ||||||
| Journal or Publication Title: | Current Opinion in Critical Care | ||||||
| Publisher: | Lippincott Williams & Wilkins | ||||||
| ISSN: | 1070-5295 | ||||||
| Official Date: | December 2021 | ||||||
| Dates: |
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| Volume: | 27 | ||||||
| Number: | 6 | ||||||
| Page Range: | pp. 649-655 | ||||||
| DOI: | 10.1097/MCC.0000000000000877 | ||||||
| Status: | Peer Reviewed | ||||||
| Publication Status: | Published | ||||||
| Access rights to Published version: | Restricted or Subscription Access |
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