European Resuscitation Council and European Society of Intensive Care Medicine Guidelines 2021: Post-resuscitation care

Abstract

The European Resuscitation Council (ERC) and the European Society of Intensive Care Medicine (ESICM) have collaborated to produce these postresuscitation care guidelines for adults, which are based on the 2020 International Consensus on Cardiopulmonary Resuscitation Science with Treatment Recommendations. The topics covered include the post-cardiac arrest syndrome, diagnosis of cause of cardiac arrest, control of oxygenation and ventilation, coronary reperfusion, haemodynamic monitoring and management, control of seizures, temperature control, general intensive care management, prognostication, long-term outcome, rehabilitation, and organ donation.

Absolute serum neurofilament light chain levels and its early kinetics predict brain injury after out-of-hospital cardiac arrest

“…The prognostication strategy algorithm proposed by the European Resuscitation Council and the European Society of Intensive Care Medicine [4] was used to identify patients with sHIBI among individuals with poor outcome (CPC3-5), independently assessed by two of the authors (HG, CW).…”

“…Among the patients with CPC3-5, 12 of 23 (52%) individuals had an absolute NFL > 508.6 pg/ml at day 2, and a change in NFL > 494 pg/ml comparing the value at day 2 and day 0. Eleven of these 12 patients fulfilled the criteria for "poor outcome likely" (termed severe hypoxic-ischemic brain injury (sHIBI), Table 2) according to the prognostication strategy algorithm proposed by the European Resuscitation Council and the European Society of Intensive Care Medicine [4]. Thus, NFL was elevated in 100% of the patients with predicted sHIBI.…”

“…However, most of these deaths are not directly caused by sHIBI but rather result from withdrawal of life support (WLS) following unfavorable neuroprognostication [2,3]. The 2021 joint guidelines of the European Resuscitation Council (ERC) and the European Society of Intensive Care Medicine recommend neuroprognostication no earlier than 72 h after return of spontaneous circulation (ROSC) and in comatose patients with a motor response ≤ 3 of the Glasgow Coma Scale (abnormal flexion, extension, or nil) [4]. The use of sedatives and targeted temperature management (TTM) is among the reasons for this suggestion.…”

Multimodal Approach to Predict Neurological Outcome after Cardiac Arrest: A Single-Center Experience

“…Sudden cardiac arrest (CA) is a common disease [ 1 ]; despite all the advances in cardiopulmonary resuscitation (CPR), survival of CA victims is around 10% [ 2 , 3 ]. After the return of spontaneous circulation (ROSC), the global ischemia/reperfusion injury, (i.e., post cardiac arrest syndrome) including brain injury, myocardial dysfunction, systemic inflammatory response [ 4 ], is responsible for a large proportion of in-hospital mortality [ 5 ].…”

“…As such, additional prognostic tools are needed. In 2021, International Guidelines recommended assessing neurological prognosis among comatose CA survivors using a combination of different tests; in particular, poor outcome would likely occur when two or more predictors, including highly malignant electroencephalography (EEG, considered as suppressed background or burst-suppression) at >24 h, neuron-specific enolase (NSE) >60 mcg/L at 48 h and/or 72 h, absence of pupillary and/or corneal reflex at >72 h, absence of cortical response (N20) to short-latency somatosensory evoked potentials (SSEPs) at >24 h, onset of status myoclonus ≤72 h, extensive brain injury at MRI/CT scan, were present [ 3 ].…”