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Post-cardiac Arrest Management

  • Cindy H. HsuEmail author
  • Robert W. Neumar
Chapter
  • 5 Downloads

Abstract

This chapter will review the elements of cardiac arrest resuscitation that begin after return of spontaneous circulation (ROSC). In-hospital mortality of patients who achieve ROSC long enough to be admitted to an intensive care unit (ICU) averages 60% with wide inter-institutional variability (40–80%) (Carr et al., Resuscitation 80:30–34, 2009; Straney et al., Crit Care Resusc 16:104–111, 2014; Nolan et al., Crit Care 20:219, 2016). The pathophysiology of post-cardiac arrest syndrome (PCAS) is composed of four major components: post-cardiac arrest brain injury, post-cardiac arrest myocardial dysfunction, systemic ischemia/reperfusion response, and persistent precipitating pathology (Neumar et al., Circulation 118:2452–2483, 2008). It is important to recognize that each component is potentially reversible and responsive to therapy. A comprehensive multidisciplinary management strategy that addresses all components of PCAS is critical to achieve optimal patient outcome. In addition, a reliable multimodal strategy to prognosticate neurologic outcome in comatose patients is essential to prevent premature cessation of care and enable appropriate resource utilization (Callaway et al., Circulation 132:S465–S482, 2015).

Keywords

Cardiac arrest Post-cardiac arrest syndrome Hypothermic targeted temperature management Percutaneous coronary intervention Cardiogenic shock Goal-directed resuscitation Neuroprognostication 

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© Springer Nature Switzerland AG 2020

Authors and Affiliations

  1. 1.Department of Emergency MedicineUniversity of Michigan Medical SchoolAnn ArborUSA
  2. 2.Department of SurgeryUniversity of Michigan Medical SchoolAnn ArborUSA
  3. 3.Michigan Center for Integrative Research in Critical CareUniversity of Michigan Medical SchoolAnn ArborUSA

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