. 2021 Apr;47(4):369-421.

doi: 10.1007/s00134-021-06368-4. Epub 2021 Mar 25.

European Resuscitation Council and European Society of Intensive Care Medicine guidelines 2021: post-resuscitation care

Jerry P Nolan^#^{1

2}, Claudio Sandroni^#^{3

4}, Bernd W Böttiger⁵, Alain Cariou⁶, Tobias Cronberg⁷, Hans Friberg⁸, Cornelia Genbrugge^{9

10}, Kirstie Haywood¹¹, Gisela Lilja¹², Véronique R M Moulaert¹³, Nikolaos Nikolaou¹⁴, Theresa Mariero Olasveengen¹⁵, Markus B Skrifvars¹⁶, Fabio Taccone¹⁷, Jasmeet Soar¹⁸

Affiliations

¹ University of Warwick, Warwick Medical School, Coventry, CV4 7AL, UK. jerry.nolan@nhs.net.
² Royal United Hospital, Bath, BA1 3NG, UK. jerry.nolan@nhs.net.
³ Department of Intensive Care, Emergency Medicine and Anaesthesiology, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Rome, Italy.
⁴ Institute of Anaesthesiology and Intensive Care Medicine, Università Cattolica del Sacro Cuore, Rome, Italy.
⁵ Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Cologne, Kerpener Straße 62, 50937, Cologne, Germany.
⁶ Cochin University Hospital (APHP) and University of Paris (Medical School), Paris, France.
⁷ Department of Clinical Sciences, Neurology, Lund University, Skane University Hospital, Lund, Sweden.
⁸ Department of Clinical Sciences, Anaesthesia and Intensive Care Medicine, Lund University, Skane University Hospital, Lund, Sweden.
⁹ Acute Medicine Research Pole, Institute of Experimental and Clinical Research (IREC), Université Catholique de Louvain, Brussels, Belgium.
¹⁰ Emergency Department, University Hospitals Saint-Luc, Brussels, Belgium.
¹¹ Warwick Research in Nursing, Division of Health Sciences, Warwick Medical School, University of Warwick, Room A108, Coventry, CV4 7AL, UK.
¹² Department of Clinical Sciences Lund, Neurology, Lund University, Skane University Hospital, Lund, Sweden.
¹³ Department of Rehabilitation Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
¹⁴ Cardiology Department, Konstantopouleio General Hospital, Athens, Greece.
¹⁵ Department of Anesthesiology, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
¹⁶ Department of Emergency Care and Services, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
¹⁷ Department of Intensive Care, Hôpital Erasme, Université Libre de Bruxelles, Route de Lennik, 808, 1070, Brussels, Belgium.
¹⁸ Southmead Hospital, North Bristol NHS Trust, Bristol, BS10 5NB, UK.

^# Contributed equally.

PMID: 33765189
PMCID: PMC7993077
DOI: 10.1007/s00134-021-06368-4

European Resuscitation Council and European Society of Intensive Care Medicine guidelines 2021: post-resuscitation care

Jerry P Nolan et al. Intensive Care Med. 2021 Apr.

. 2021 Apr;47(4):369-421.

doi: 10.1007/s00134-021-06368-4. Epub 2021 Mar 25.

Authors

Affiliations

¹ University of Warwick, Warwick Medical School, Coventry, CV4 7AL, UK. jerry.nolan@nhs.net.
² Royal United Hospital, Bath, BA1 3NG, UK. jerry.nolan@nhs.net.
³ Department of Intensive Care, Emergency Medicine and Anaesthesiology, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Rome, Italy.
⁴ Institute of Anaesthesiology and Intensive Care Medicine, Università Cattolica del Sacro Cuore, Rome, Italy.
⁵ Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Cologne, Kerpener Straße 62, 50937, Cologne, Germany.
⁶ Cochin University Hospital (APHP) and University of Paris (Medical School), Paris, France.
⁷ Department of Clinical Sciences, Neurology, Lund University, Skane University Hospital, Lund, Sweden.
⁸ Department of Clinical Sciences, Anaesthesia and Intensive Care Medicine, Lund University, Skane University Hospital, Lund, Sweden.
⁹ Acute Medicine Research Pole, Institute of Experimental and Clinical Research (IREC), Université Catholique de Louvain, Brussels, Belgium.
¹⁰ Emergency Department, University Hospitals Saint-Luc, Brussels, Belgium.
¹¹ Warwick Research in Nursing, Division of Health Sciences, Warwick Medical School, University of Warwick, Room A108, Coventry, CV4 7AL, UK.
¹² Department of Clinical Sciences Lund, Neurology, Lund University, Skane University Hospital, Lund, Sweden.
¹³ Department of Rehabilitation Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
¹⁴ Cardiology Department, Konstantopouleio General Hospital, Athens, Greece.
¹⁵ Department of Anesthesiology, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
¹⁶ Department of Emergency Care and Services, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
¹⁷ Department of Intensive Care, Hôpital Erasme, Université Libre de Bruxelles, Route de Lennik, 808, 1070, Brussels, Belgium.
¹⁸ Southmead Hospital, North Bristol NHS Trust, Bristol, BS10 5NB, UK.

^# Contributed equally.

PMID: 33765189
PMCID: PMC7993077
DOI: 10.1007/s00134-021-06368-4

Abstract

The European Resuscitation Council (ERC) and the European Society of Intensive Care Medicine (ESICM) have collaborated to produce these post-resuscitation care guidelines for adults, which are based on the 2020 International Consensus on Cardiopulmonary Resuscitation Science with Treatment Recommendations. The topics covered include the post-cardiac arrest syndrome, diagnosis of cause of cardiac arrest, control of oxygenation and ventilation, coronary reperfusion, haemodynamic monitoring and management, control of seizures, temperature control, general intensive care management, prognostication, long-term outcome, rehabilitation and organ donation.

Keywords: Cardiac arrest; Guidelines; Post resuscitation care; Prognostication.

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Conflict of interest statement

JPN: Editor in Chief Resuscitation. CS: Associate Editor, Intensive Care Medicine. BWB: Treasurer of the European Resuscitation Council (ERC); Chairman of the German Resuscitation Council (GRC); Member of the Advanced Life Support (ALS) Task Force of the International Liaison Committee on Resuscitation (ILCOR); Member of the Executive Committee of the German Interdisciplinary Association for Intensive Care and Emergency Medicine (DIVI), Founder of the Deutsche Stiftung Wiederbelebung; Associate Editor of the European Journal of Anaesthesiology (EJA), Co-Editor of Resuscitation; Editor of Notfall + Rettungsmedizin, Co-Editor of the Brazilian Journal of Anesthesiology. Received fees for lectures from the following companies: Forum für medizinische Fortbildung (FomF), Baxalta Deutschland GmbH, ZOLL Medical Deutschland GmbH, C.R. Bard GmbH, GS Elektromedizinische Geräte G. Stemple GmbH, Novartis Pharma GmbH, Philips GmbH Market DACH, Bioscience Valuation BSV GmbH. AC: Speaker’s Fee from Bard Medical. TC: no conflicts of interest. HF: no conflicts of interest. CG: no conflicts of interest. GL: no conflicts of interest. VRMM: no conflicts of interest. NN: no conflicts of interest. TMO: no conflicts of interest. MBS: Speaker’s Fee from Bard Medical (Ireland). FST: Speaker’s Fees from BD and Zoll. JS: Editor, Resuscitation.

Figures

**Fig. 1**
Post resuscitation care algorithm. *SBP* systolic blood pressure, *PCI* percutaneous coronary intervention, *CTPA* computed tomography pulmonary angiogram, *ICU* intensive care unit, *EEG* electroencephalography, *ICD* implanted cardioverter defibrillator

**Fig. 2**
Haemodynamic, oxygenation and ventilation targets

**Fig. 3**
Prognostication modes. *EEG* electroencephalography, *NSE* neuron specific enolase, *SSEP* somatosensory evoked potential

**Fig. 4**
Prognostication strategy algorithm. *EEG* electroencephalography, *NSE* neuron specific enolase, *SSEP* somatosensory evoked potential, *ROSC* return of spontaneous circulation. 1. Major confounders may include sedation, neuromuscular blockade, hypothermia, severe hypotension, hypoglycaemia, sepsis, and metabolic and respiratory derangements. 2. Use an automated pupillometer, when available, to assess pupillary light reflex. 3. Suppressed background ± periodic discharges or burst-suppression, according to ACNS. 4. Increasing NSE values between 24 h-48 h or 24/48 h and 72 h further confirm a likely poor outcome. 5. Defined as a continuous and generalised myoclonus persisting for 30 min or more. *Caution in case of discordant signs indicating a potentially good outcome (see text for details)

**Fig. 5**
Recommendations for in-hospital functional assessments, follow-up and rehabilitation after cardiac arrest

**Fig. 6**
Organ donation after cardiac arrest algorithm. *Includes a 24-h observation period after rewarming to 36 °C before clinical testing for brain death/death by neurological criteria [406]. *WLST* withdrawal of life sustaining treatment Adapted from [286]

See this image and copyright information in PMC

Comment in

"Do no further harm" - Why shall we sedate unresponsive patients?
Kalbhenn J, Knörlein J, Posch MJ. Kalbhenn J, et al. Intensive Care Med. 2021 Jul;47(7):807-808. doi: 10.1007/s00134-021-06422-1. Epub 2021 May 5. Intensive Care Med. 2021. PMID: 33954840 Free PMC article. No abstract available.
Why we should sedate unresponsive patients after resuscitation.
Sandroni C, Soar J, Nolan JP. Sandroni C, et al. Intensive Care Med. 2021 Jul;47(7):809-810. doi: 10.1007/s00134-021-06423-0. Epub 2021 May 11. Intensive Care Med. 2021. PMID: 33974108 No abstract available.

References

1. Nolan JP, Soar J, Cariou A, et al. European Resuscitation Council and European Society of Intensive Care Medicine Guidelines for post-resuscitation Care 2015: section 5 of the European Resuscitation Council Guidelines for Resuscitation 2015. Resuscitation. 2015;95:202–222. doi: 10.1016/j.resuscitation.2015.07.018. - DOI - PubMed
1. Nolan JP, Soar J, Cariou A, et al. European Resuscitation Council and European Society of Intensive Care Medicine 2015 guidelines for post-resuscitation care. Intensive Care Med. 2015;41:2039–2056. doi: 10.1007/s00134-015-4051-3. - DOI - PubMed
1. Nolan JP, Hazinski MF, Aickin R, et al. Part 1: executive summary: 2015 international consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations. Resuscitation. 2015;95:e1–e31. doi: 10.1016/j.resuscitation.2015.07.039. - DOI - PubMed
1. Olasveengen TM, de Caen AR, Mancini ME, et al. 2017 International consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations summary. Resuscitation. 2017;121:201–214. doi: 10.1016/j.resuscitation.2017.10.021. - DOI - PubMed
1. Soar J, Donnino MW, Maconochie I, et al. 2018 international consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations summary. Resuscitation. 2018;133:194–206. doi: 10.1016/j.resuscitation.2018.10.017. - DOI - PubMed

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European Resuscitation Council and European Society of Intensive Care Medicine guidelines 2021: post-resuscitation care

Affiliations

European Resuscitation Council and European Society of Intensive Care Medicine guidelines 2021: post-resuscitation care

Authors

Affiliations

Abstract

Conflict of interest statement

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References

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