Haemodynamic and ventilator management in patients following cardiac arrest

Abstract

Purpose of review: The purpose of this study is to review the recent literature describing how to assess and treat postcardiac arrest syndrome associated haemodynamics and manage oxygenation and ventilation derangements.

Recent findings: Postcardiac arrest syndrome is a well described entity that includes systemic ischemia-reperfusion response, myocardial dysfunction and neurologic dysfunction. Continued resuscitation in the hours to days following return of spontaneous circulation (ROSC) is important to increase the likelihood of long-term survival and neurological recovery. Post-ROSC hypotension is common and associated with worse outcome. Myocardial dysfunction peaks in the first 24 h following ROSC and in survivors resolves over the next few days. Hyperoxemia (paO₂>300 mmHg) and hypoxemia (paO₂<60 mmHg) are associated with worse outcomes and hyperventilation may exacerbate cerebral ischemic injury by decreasing cerebral oxygenation.

Summary: Patients who are successfully resuscitated from cardiac arrest often have hypotension and myocardial dysfunction. Careful attention to haemodynamic and ventilator management targeting normal blood pressure, normoxemia and normocapnia may help to avoid secondary organ injury and potentially improve outcomes.

FIGURE 1

An algorithm to evaluate and treat hypotension in the patient resuscitated from cardiac arrest after hospital admission. CVP, central venous pressure; ScvO₂, central venous saturation.

FIGURE 2

A step-by-step algorithm to adjust oxygen and carbon dioxide levels in patients resuscitated from cardiac arrest after hospital admission. FiO₂, fraction of inspired oxygen; MV_ent, minute ventilation; SpO₂, peripheral capillary oxygen saturation.