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

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.

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]