Beyond return of spontaneous circulation: update on post-cardiac arrest management in the intensive care unit

Abstract

A well-functioning chain of survival is critical for good outcomes following out-of-hospital cardiac arrest, a major public health concern in Singapore. While the percentage of survivors to hospital admission has increased over the years, the percentage of survivors to hospital discharge and the number of patients with good neurological recovery can be greatly improved. This underscores the urgent need to focus on ‘post-cardiac arrest care’, the fifth link in the chain of survival, to improve the outcomes of patients who are admitted to the intensive care unit (ICU) after return of spontaneous circulation. This review builds on earlier recommendations of the Singapore National Targeted Temperature Management Workgroup in 2017 to provide a focused update on post-cardiac arrest management and a practical guide for physicians managing resuscitated patients with cardiac arrest in the ICU.

Long term survival and disease burden from out-of-hospital cardiac arrest in Singapore: a population-based cohort study

“… 20 This result from a cohort of initial OHCA survivors in a small city-state may have been influenced by nation-wide improvements to OHCA interventions, 34 ranging from community interventions such as the MyResponder phone application to improve rates of bystander CPR and AED use 35 to post-resuscitation interventions including coronary angiography (CAG) with percutaneous coronary intervention (PCI) 36 and targeted temperature management (TTM). 37 , 38 , 39 Although bystander CPR was not significantly associated with long-term survival in this study, the sum effect of these interventions may have improved short-term neurological outcomes, which was significantly associated with long-term survival here and elsewhere. 40 Yet, this encouraging result should not imply that OHCA has a decreasing public health burden, since total DALY may increase in the future considering Singapore's aging population and the association between older age and mortality.…”

Revisión del Síndrome Post Parada Cardíaca

“…Del mismo modo, se recomienda realizar una analítica sanguínea de entrada, que incluya los valores de glucosa, urea, electrolitos, así como una gasometría arterial, marcadores de lesión miocárdica, coagulación y hematimetría, con el fin de diagnosticar infarto agudo de miocardio, corregir alteraciones metabólicas y hemodinámicas, que puedan complicar el cuadro clínico del paciente (Chia et al,2021).…”

“…Finalmente, se deberá realizar una placa de Rx portátil, con el objetivo de asegurar la colocación adecuada del tubo endotraqueal que servirá para la monitorización del paciente, la cual debe incluir estudios electrocardiográficos continuos os seriados, evaluación de los signos vitales, presión arterial media (PAM), presión venosa central (PVC), diuresis por catéter vesical, saturación venosa central de oxígeno y temperatura central mediante sonda térmica vesical, pulmonar o esofágica. En el caso de complicaciones, será necesario un estudio hemodinámico avanzado (Chia et al,2021).…”

SRFAC: resuscitation and saving lives in the COVID-19 era and beyond

“…The Singapore National Targeted Temperature Management Workgroup summarises recent advancements in post-cardiac arrest management, including the use of advanced neurological monitoring and the importance of a good-quality intensive care unit care in the post-ROSC period. (11) Post-cardiac arrest care in the intensive care unit with a well-orchestrated, multidisciplinary, multisystemic approach is crucial for overall good prognosis.…”