Beyond return of spontaneous circulation: update on post-cardiac arrest management in the intensive care unit

Abstract

A well-functioning chain of survival is critical for good outcomes following out-of-hospital cardiac arrest, a major public health concern in Singapore. While the percentage of survivors to hospital admission has increased over the years, the percentage of survivors to hospital discharge and the number of patients with good neurological recovery can be greatly improved. This underscores the urgent need to focus on 'post-cardiac arrest care', the fifth link in the chain of survival, to improve the outcomes of patients who are admitted to the intensive care unit (ICU) after return of spontaneous circulation. This review builds on earlier recommendations of the Singapore National Targeted Temperature Management Workgroup in 2017 to provide a focused update on post-cardiac arrest management and a practical guide for physicians managing resuscitated patients with cardiac arrest in the ICU.

Keywords: intensive care unit; post-cardiac arrest syndrome; targeted temperature management.

Fig. 1

Management of post-cardiac arrest syndrome: the ‘A to I’ approach. DVT: deep venous thrombosis; EEG: electroencephalography; ETT: endotracheal tube; ICP: intracranial pressure; KIV: keep in view; MAP: mean arterial pressure; PEEP: positive end expiratory pressure; ScvO₂: central venous oxygen saturation; US: ultrasonography; VAP: ventilator-associated pneumonia [adapted with permission from Ng S and Chia YW].(30)