Advances in postresuscitation care

Abstract

A co-ordinated, evidence-based approach to treatments following cardiac arrest can have a significant impact on outcome. In comatose survivors of cardiac arrest, therapeutic hypothermia (temp 32-34°C) should be induced as soon as possible and maintained for 12-24 hours before controlled rewarming. Cardiac impairment is usually transient and responds to fluids and vasopressors/inotropes. Aim for a mean arterial blood pressure to achieve adequate end organ perfusion. Patients with a suspected cardiac cause of their arrest should be considered for angiography with or without percutaneous transluminal coronary angioplasty (PTCA). Hyperglycaemia should be treated with insulin. Controlled ventilation should aim for oxygen saturations of 94-96% and normocapnia. Prognostic tests are unreliable initially and should be deferred until at least 72 hours following return of normothermia. © The Intensive Care Society 2010.