Arterial Blood Pressure and Neurologic Outcome After Resuscitation From Cardiac Arrest*

Kilgannon, J. Hope; Roberts, Brian W.; Jones, Alan E.; Mittal, Neil; Cohen, Evan; Mitchell, Jessica; Chansky, Michael E.; Trzeciak, Stephen

doi:10.1097/ccm.0000000000000406

Cited by 134 publications

(119 citation statements)

References 59 publications

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“…In patients with hypotension (e.g., SBP < 90), a midazolam infusion may be used. Of note, recent publications suggest that hypotension (MAP <75-80 mmHg) is associated with poor outcome after CA [14,35]. However, the half-life of midazolam is prolonged during TH and may reduce the accuracy of the neurologic examination [36].…”

Section: Sedation and Shiveringmentioning

confidence: 96%

“…One of the key neurocritical care interventions that has helped improve outcomes is the implementation of therapeutic hypothermia (TH) that is accompanied by a clear post-arrest care plan [8][9][10][11]. This should include appropriate ventilation to prevent hypoxia and hyperoxia as well as hypo-and hypercarbia [12], prevention of hypotension [13,14], immediate coronary intervention when appropriate [15], and delayed neuroprognostication. In a large trial, the rate of survival with good neurologic outcome was 59.7 % in patients with witnessed VT/VF arrest [16].…”

Section: Introductionmentioning

confidence: 99%

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Emergency Neurological Life Support: Resuscitation Following Cardiac Arrest

2015

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Cardiac arrest is the most common cause of death in North America. Neurocritical care interventions, including targeted temperature management (TTM), have significantly improved neurological outcomes in patients successfully resuscitated from cardiac arrest. Therefore, resuscitation following cardiac arrest was chosen as an emergency neurological life support protocol. Patients remaining comatose following resuscitation from cardiac arrest should be considered for TTM. This protocol will review induction, maintenance, and re-warming phases of TTM, along with management of TTM side effects. Aggressive shivering suppression is necessary with this treatment to ensure the maintenance of a target temperature. Ancillary testing, including electrocardiography, computed tomography and/or magnetic resonance imaging of the brain, continuous electroencephalography monitoring, and correction of electrolyte, blood gas, and hematocrit changes, are also necessary to optimize outcomes.

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Section: Sedation and Shiveringmentioning

confidence: 96%

Section: Introductionmentioning

confidence: 99%

Emergency Neurological Life Support: Resuscitation Following Cardiac Arrest

2015

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“…As we previously mentioned the injured brain commonly has a dysfunctional autoregulation. This leads to the fact that blood pressure alterations in the post-cardiac arrest period may influence on-going cerebral injury and eventual neurologic outcome [51]. With disruption of normal cerebrovascular autoregulation, CBF may become directly related to cerebral perfusion pressure, which is dependent on MAP.…”

Section: Cerebral Perfusionmentioning

confidence: 99%

“…Kilgannon et al studied the time-weighted average mean arterial pressure (TWA-MAP) for the first 6 hours after ROSC [51]. It was found that arterial hypotension was common while relatively fewer patients had an intrinsic hypertensive surge.…”

Section: Cerebral Perfusionmentioning

confidence: 99%

Strategies of Neuroprotection after Successful Resuscitation

Kovács¹,

Zima²

2017

Resuscitation Aspects

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Post-cardiac arrest syndrome (PCAS) incorporates post-cardiac arrest brain injury, postcardiac arrest myocardial dysfunction, systemic ischemia/reperfusion syndrome and the precipitating pathology. Brain injury remains the leading cause of death in the postcardiac arrest period. One of our main goals during post-resuscitation care is to guide a proper neuroprotective strategy. We are going to summarize the tools of neuroprotection in post-cardiac arrest therapy. The role of normoxia/normocapnia, normoglycemia, seizure control, sedation and pharmacologic strategies will be discussed in brief. The handling of temperature management and the management of hemodynamic variables to secure satisfactory cerebral perfusion will be worked out in details. Targeted temperature management is the main tool of neuroprotection in post-cardiac arrest therapy. We are going to conclude the principles of temperature control after successful resuscitation pointing out its beneficial effects. This method has also several complications that are going to be discussed highlighting its hemodynamic impacts. There is no evidence about target hemodynamic parameters during post-cardiac arrest syndrome to maintain cerebral perfusion neither about the most effective hemodynamic monitoring system. We are presenting preliminary data of our study where we investigate the effect of PiCCO™ (Pulse index Continous Cardiac Output) monitoring on the outcome in this patient group.Keywords: post-cardiac arrest syndrome, post-cardiac arrest brain injury, post-resuscitation therapy, targeted temperature management, hemodynamic parameters IntroductionSudden cardiac arrest is one of the leading causes of death in Europe [1]. The outcome is still very poor: the hospital discharge varies between 7 and 10% after out-of-hospital cardiac arrest (OHCA) and it is approximately 25% after in-hospital cardiac arrest (IHCA) [1]. The chain of © 2017 The Author(s). Licensee InTech. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.survival describes links that lead to a successful resuscitation [2]. The fourth element covers proper post-resuscitation care to restore quality of life. It is well known that the management of post-resuscitation cardiac arrest syndrome affects outcome and it is an important part of the resuscitation process. Pointing out the growing importance of post-resuscitation therapy, the European Resuscitation Council (ERC) introduced a separate chapter about post-resuscitation care in the 2015 guidelines [3]. One of the key elements to improve survival rate after sudden cardiac arrest may be the enhancement of post-resuscitation therapy.The post-cardiac arrest brain injury remains the main cause of mortality in the post-cardiac arrest period, being as high as 68% after OHCA and 25% after IHCA [4]. These data show that one of our leading goa...

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“…Critical Care Management for Cardiac Arrest tional study assessed the relationship between MAP and outcome after ROSC, finding a time-weighted average MAP ≥70 mmHg was associated with a better neurologic outcome than lower levels. 49 In a retrospective study, MAP ≥100 mmHg during the 2 h after ROSC was associated with better neurologic recovery at hospital discharge. 50 On the other hand, a study by Young and colleagues found no relationship between higher MAP during therapeutic hypothermia and neurologically intact survival.…”

Section: Cbf and Metabolismmentioning

confidence: 99%

Critical Care Management Focused on Optimizing Brain Function After Cardiac Arrest

Nakashima

Hifumi

Kawakita

et al. 2017

Circ J

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The discussion of neurocritical care management in post-cardiac arrest syndrome (PCAS) has generally focused on target values used for targeted temperature management (TTM). There has been less attention paid to target values for systemic and cerebral parameters to minimize secondary brain damage in PCAS. And the neurologic indications for TTM to produce a favorable neurologic outcome remain to be determined. Critical care management of PCAS patients is fundamental and essential for both cardiologists and general intensivists to improve neurologic outcome, because definitive therapy of PCAS includes both special management of the cause of cardiac arrest, such as coronary intervention to ischemic heart disease, and intensive management of the results of cardiac arrest, such as ventilation strategies to avoid brain ischemia. We reviewed the literature and the latest research about the following issues and propose practical care recommendations. Issues are (1) prediction of TTM candidate on admission, (2) cerebral blood flow and metabolism and target value of them, (3) seizure management using continuous electroencephalography, (4) target value of hemodynamic stabilization and its method, (5) management and analysis of respiration, (6) sedation and its monitoring, (7) shivering control and its monitoring, and (8) glucose management. We hope to establish standards of neurocritical care to optimize brain function and produce a favorable neurologic outcome.

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Arterial Blood Pressure and Neurologic Outcome After Resuscitation From Cardiac Arrest*

Abstract: We found that time-weighted average mean arterial pressure was associated with good neurologic outcome at a threshold of mean arterial pressure greater than 70 mm Hg.

Cited by 134 publications

References 59 publications

Emergency Neurological Life Support: Resuscitation Following Cardiac Arrest

Emergency Neurological Life Support: Resuscitation Following Cardiac Arrest

Strategies of Neuroprotection after Successful Resuscitation

Critical Care Management Focused on Optimizing Brain Function After Cardiac Arrest

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