O SlideShare utiliza cookies para otimizar a funcionalidade e o desempenho do site, assim como para apresentar publicidade mais relevante aos nossos usuários. Se você continuar a navegar o site, você aceita o uso de cookies. Leia nosso Contrato do Usuário e nossa Política de Privacidade.
O SlideShare utiliza cookies para otimizar a funcionalidade e o desempenho do site, assim como para apresentar publicidade mais relevante aos nossos usuários. Se você continuar a utilizar o site, você aceita o uso de cookies. Leia nossa Política de Privacidade e nosso Contrato do Usuário para obter mais detalhes.
Post-Cardiac Arrest Syndrome:
Epidemiology, Pathophysiology, Treatment, and Prognostication
A Consensus Statement From the International Liaison Committee on Resuscitation
ILCOR Consensus StatementPost-Cardiac Arrest Syndrome: Epidemiology, Pathophysiology, Treatment, and PrognosticationA Consensus Statement From the International Liaison Committee on Resuscitation<br />Circulation. 2008;118:2452-2483<br />
Epidemiology<br />The largest published in-hospital cardiac arrest database (theNRCPR) includes data from >36000 cardiac arrests.<br />In-hospital mortalityrate was 67% for the 19819 adults with any documented ROSC,<br />62% for the 17183 adults with ROSC >20 minutes.<br />
Circulatory Support<br />Dysrhythmias can be treated by maintenance of normal electrolyteconcentrations, use of standard drug and electrical therapies.<br />The first-line intervention for hypotension is to optimize right-heart filling pressures by use of IV fluids. In 1 study,3.5 to 6.5 L of IV crystalloid was required in thefirst 24 hours after ROSC after OHCAto maintain CVP in the range of 8 to 13 mmHg.<br />
Circulatory Support<br />Inotropes and vasopressors should be considered if hemodynamicgoals are not achieved despite optimized preload.<br />Early echocardiography willenable the extent of myocardial dysfunction to be quantifiedand may guide therapy. <br />Additionalcardiac support: intra-aorticballoon pump (IABP), percutaneous cardiopulmonary bypass, extracorporeal membraneoxygenation (ECMO), transthoracic ventricular assist devices.<br />
Management of ACS<br />Patients resuscitated from cardiac arrest who have ST-elevation myocardial infarctionshould undergo immediate coronary angiography, with subsequentPCI if indicated.<br />It is appropriate toconsider immediate coronary angiography in all post–cardiacarrest patients in whom ACS is suspected.<br />
Therapeutic Hypothermia<br />Unconscious adult patientswith ROSC after out-of-hospital VF cardiacarrest should be cooled to 32°C to 34°C for at least12 to 24 hours.<br />Rapid IV infusion of ice-cold 0.9% salineor Ringer’s lactate (30 mL/kg) is a simple, effectivemethod for initiating cooling.<br />Slow rewarming: 0.25°C to 0.5°C per hour.<br />If therapeutic hypothermia is not undertaken, pyrexia duringthe first 72 hours after cardiac arrest should be treated aggressivelywith antipyretics or active cooling.<br />
Sedation and Neuromuscular Blockade<br />Critically ill post–cardiac arrest patientswill require sedation for mechanical ventilation and therapeutichypothermia. <br />Adequate sedation is particularly important for prevention ofshivering during induction of therapeutic hypothermia, maintenance,and rewarming.<br />
Seizure Control and Prevention<br />Prolonged seizures may cause cerebral injury andshould be treated promptly and effectively with benzodiazepines,phenytoin, sodium valproate, propofol, or a barbiturate.<br />Clonazepam is the drug of choice for the treatmentof myoclonus. <br />
Glucose Control<br />Tight control blood glucose (80 to 110mg/dL) with insulin reduced hospital mortality rates in criticallyill adults.<br />
Placement of Implantable Cardioverter-Defibrillators<br />In survivors with good neurological recovery, insertion of anICD is indicated if subsequentcardiac arrests cannot be reliably prevented by other treatments(such as pacemaker for AV block, transcatheterablation of a single ectopic pathway, or valve replacement forcritical aortic stenosis).<br />