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Post-resuscitation care following out-of-hospital and in-hospital cardiac arrest
  1. Saket Girotra1,
  2. Paul S Chan2,
  3. Steven M Bradley3
  1. 1Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
  2. 2Saint Luke's Mid America Heart Institute and the University of Missouri-Kansas City, VA Eastern Colorado Health Care System, Denver, Colorado, USA
  3. 3University of Colorado School of Medicine at the Anschutz Medical Campus, Aurora, Colorado, USA
  1. Correspondence to Dr Saket Girotra, Assistant Professor of Medicine, Division of Cardiovascular Diseases, Department of Internal Medicine, University of Iowa Carver College of Medicine, 200 Hawkins Drive, Suite 4427 RCP, Iowa City, IA 52242, USA; saket-girotra{at}uiowa.edu

Abstract

Cardiac arrest is a leading cause of death in developed countries. Although a majority of cardiac arrest patients die during the acute event, a substantial proportion of cardiac arrest deaths occur in patients following successful resuscitation and can be attributed to the development of post-cardiac arrest syndrome. There is growing recognition that integrated post-resuscitation care, which encompasses targeted temperature management (TTM), early coronary angiography and comprehensive critical care, can improve patient outcomes. TTM has been shown to improve survival and neurological outcome in patients who remain comatose especially following out-of-hospital cardiac arrest due to ventricular arrhythmias. Early coronary angiography and revascularisation if needed may also be beneficial during the post-resuscitation phase, based on data from observational studies. In addition, resuscitated patients usually require intensive care, which includes mechanical ventilator, haemodynamic support and close monitoring of blood gases, glucose, electrolytes, seizures and other disease-specific intervention. Efforts should be taken to avoid premature withdrawal of life-supporting treatment, especially in patients treated with TTM. Given that resources and personnel needed to provide high-quality post-resuscitation care may not exist at all hospitals, professional societies have recommended regionalisation of post-resuscitation care in specialised ‘cardiac arrest centres’ as a strategy to improve cardiac arrest outcomes. Finally, evidence for post-resuscitation care following in-hospital cardiac arrest is largely extrapolated from studies in patients with out-of-hospital cardiac arrest. Future studies need to examine the effectiveness of different post-resuscitation strategies, such as TTM, in patients with in-hospital cardiac arrest.

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