[Postresuscitation care]

Abstract

Witnessed collapse, bystander resuscitation and the use of automated external defibillators for defibrillatable arrhythmias, are recognized as strong predictors for a good prognosis after cardiac arrest. In addition, patient care after return of spontaneous circulation (ROSC), i.e. postresuscitation care, has been identified as an important factor for survival. It is necessary to differentiate between measures for treating the underlying cause of the cardiac arrest and measures for limiting reperfusion injury after global hypoxia and ischemia. The importance of urgent coronary angiography in cases of ST-elevation myocardial infarction (STEMI) and for patients with suspected cardiac origin without STEMI, especially with hemodynamic instability is emphasized in the current European Resuscitation Council (ERC) guidelines. In order to minimize reperfusion injury targeted temperature management (32-36 °C) is advised, rewarming must be controlled and fever and hyperthermia avoided. The mean arterial pressure should be adjusted to allow sufficient urine production (1 ml/kg/h) and blood glucose should be ≤10 mmol/l (≤180 mg/dl). Analgosedation is necessary in most patients, especially with the use of targeted temperature management. Convulsive seizures must be consistently treated. Cardiac arrest centers provide a treatment strategy for postresuscitation care involving emergency percutaneous coronary angiography, targeted temperature management and comprehensive neurological evaluation for estimating the prognosis. Whether establishing these centers will actually lead to improved survival still needs to be proven.

Keywords: Coronary angiography; Elektrocardiography; Heart arrest; Percutaneous coronary intervention; Temperature management.