Management following resuscitation from cardiac arrest: Recommendations from the 2003 Rocky mountain critical care conference

Abstract

P Pu ur rp po os se e: : To propose a strategy for the management of patients admitted to critical care units after resuscitation from cardiac arrest.S So ou ur rc ce e: : Prior to the conference relevant studies were identified via literature searches and brief reviews circulated on the following topics: glucose and blood pressure management; therapeutic hypothermia; prearrest outcome prediction; post-arrest outcome prediction; and management of myocardial ischemia. Two days were devoted to assessing evidence and developing a management strategy at the conference. Consensus opinion of conference participants [intensive care unit (ICU) physicians] was used when high grade evidence was unavailable. Additional literature searches and data grading were performed post-conference. P Pr ri in nc ci ip pa al l f fi in nd di in ng gs s: : High grade evidence was lacking in most areas. Specific goals of treatment were proposed for: general care; neurologic care; respiratory care; cardiac care; and gastrointestinal care. There was adequate evidence to recommend therapeutic hypothermia for comatose patients who had witnessed ventricular fibrillation or ventricular tachycardia arrests. Conference participants supported extending therapeutic hypothermia to other presenting rhythms in selected circumstances. Additional goals included mean arterial pressure 80 to 100 mmHg, glucose 5 to 8 mmol·L -1 using insulin infusions, and PaO 2 > 100 mmHg for the first 24 hr. Absent withdrawal to pain 72 hr after resuscitation should prompt consideration of palliative care. The level of evidence for other recommendations was low.C Co on nc cl lu us si io on ns s: : The proposed management strategy represents an approach to manage patients in the ICU following resuscitation from cardiac arrest. Most of the recommendations are based on low grade evidence. Additional research is needed to improve the evidence base. A standard post-arrest management strategy could help facilitate future research. Objectif : Proposer une stratégie de traitement à adopter avec les patients admis aux unités de soins intensifs (USI) après la réanimation post-arrêt cardiaque. Source : Avant la conférence, les études utiles ont été repérées dans les publications et de brèves revues ont circulé sur

Scandinavian clinical practice guidelines on general anaesthesia for emergency situations

“…The time frame for the search has been from August 1961 to May 2009. Grading of evidence and grading of recommendations were performed according to a system first used by Bell et al 1 Table 2. According to this system, evidence is graded from A to E, where recommendation grade A indicates a recommendation based on the best evidence.…”

“…Further, it is also recommended to use an opioid to reduce the haemodynamic response to tracheal intubation. Grading of evidence from I to V according to Bell et al 1 can be found in the text, added in brackets. Graded recommendations for the choice of hypnotics and opioids can be found in Table 7.…”

“…Hence, decisions on the level of evidence and grading of recommendations have been made according to Bell et al 1 Decisions about both level of evidence and grading of recommendations can be found in the individual chapters. In the text, Grading of evidence from I to V is added in brackets, [ ], and Grading of recommendations from A to E can be found in tables and text.…”

Management of Brain Injury After Resuscitation From Cardiac Arrest

“…One study indicated that a MAP of greater than 65 mm Hg, which may support adequate coronary perfusion, probably is not sufficient to provide adequate blood supply to the brain, unless other therapies that are designed to decrease cerebral metabolic demand are implemented (eg, sedation, hypothermia) [108]. A MAP of 80 to 100 mm Hg has been suggested to be beneficial, at least for the first 24 hours after arrest [109].…”

Scandinavian Clinical practice guidelines for therapeutic hypothermia and post‐resuscitation care after cardiac arrest

“…However, larger trials are warranted to assess the advantage of early vs. late cooling in humans. It is worth noting that although it took 8 h to reach the target temperature in the HACA trial, there was still a beneficial effect on cerebral out- come and death compared with normothermic patients 21 (GOE I). The optimal duration of therapeutic hypothermia is undetermined.…”