Pharmacotherapeutic Controversies During Temperature Control After Out-of-Hospital Cardiac Arrest: A Semi-Structured Literature Review

Abstract

Post-resuscitation cardiac arrest care begins at the time of hospital admission and focuses on preventing the sequelae of ischemia-reperfusion injury, including secondary brain damage and post-cardiac arrest syndrome. Clinical practice guidelines on post-resuscitation cardiac arrest care from international medical organizations outline evidence-based practices but sometimes lack pragmatic details needed by bedside clinicians to implement change. Lack of information has required providers to extrapolate from other patient populations with acute brain injuries or utilize lower quality data from patient registries or observational studies. We organized a group of content experts to address selected pharmacotherapeutic controversies encountered during temperature control after out-of-hospital cardiac arrest in adult patients. Data on pre-hospital interventions, in-hospital cardiac arrest, and most non-pharmacologic treatments were excluded. A Delphi process was completed using three rounds of voting to reach consensus on pharmacotherapeutic controversies to review. The original list of 11 topics was narrowed iteratively and the final list included: (i) sedation and analgesia, (ii) seizures and myoclonus, (iii) shivering, and (iv) early-onset pneumonia prevention. Writing groups conducted systematic literature searches of MEDLINE using PubMed focusing on contemporary publications in the past 30 years when temperature control was considered standard care. Each section reviews the scope and management of the controversy and provides a conclusion with suggested future research directions. The information in this review is intended to support providers with the implementation of recommendations made in clinical practice guidelines on post-resuscitation cardiac arrest care and should not necessarily supplant them.

Keywords: cardiac arrest; critical care; myoclonus; pneumonia; sedation; seizure; shivering.