Part 9: Post–Cardiac Arrest Care

Peberdy, Mary Ann; Callaway, Clifton W.; Neumar, Robert W.; Geocadin, Romergryko G.; Zimmerman, Janice L.; Donnino, Michael W.; Gabrielli, A.; Silvers, Scott M.; Zaritsky, Arno; Merchant, Raina M.; Hoek, Terry L. Vanden; Kronick, Steven L.

doi:10.1161/circulationaha.110.971002

Cited by 1,446 publications

(847 citation statements)

References 287 publications

(212 reference statements)

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“…Postischemic conditioning has been shown to improve survival in swine resuscitated from CA 49. The American Heart Association's guidelines highlight reperfusion injury as a problem resuscitated patients will face 19, 50. While it remains unclear how our findings relate to this spectrum of metabolic injuries, we have demonstrated that significant differences in the metabolisms of resuscitated rats can be detected using indirect calorimetry.…”

Section: Discussionmentioning

confidence: 61%

Dissociated Oxygen Consumption and Carbon Dioxide Production in the Post–Cardiac Arrest Rat: A Novel Metabolic Phenotype

Shinozaki

Becker

Saeki³

et al. 2018

JAHA

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BackgroundThe concept that resuscitation from cardiac arrest (CA) results in a metabolic injury is broadly accepted, yet patients never receive this diagnosis. We sought to find evidence of metabolic injuries after CA by measuring O2 consumption and CO2 production (VCO 2) in a rodent model. In addition, we tested the effect of inspired 100% O2 on the metabolism.Methods and ResultsRats were anesthetized and randomized into 3 groups: resuscitation from 10‐minute asphyxia with inhaled 100% O2 (CA–fraction of inspired O2 [FIO2] 1.0), with 30% O2 (CA‐FIO 2 0.3), and sham with 30% O2 (sham‐FIO 2 0.3). Animals were resuscitated with manual cardiopulmonary resuscitation. The volume of extracted O2 (VO 2) and VCO 2 were measured for a 2‐hour period after resuscitation. The respiratory quotient (RQ) was RQ=VCO 2/VO 2. VCO 2 was elevated in CA‐FIO 2 1.0 and CA‐FIO 2 0.3 when compared with sham‐FIO 2 0.3 in minutes 5 to 40 after resuscitation (CA‐FIO 2 1.0: 16.7±2.2, P<0.01; CA‐FIO 2 0.3: 17.4±1.4, P<0.01; versus sham‐FIO 2 0.3: 13.6±1.1 mL/kg per minute), and then returned to normal. VO 2 in CA‐FIO 2 1.0 and CA‐FIO 2 0.3 increased gradually and was significantly higher than sham‐FIO 2 0.3 2 hours after resuscitation (CA‐FIO 2 1.0: 28.7±6.7, P<0.01; CA‐FIO 2 0.3: 24.4±2.3, P<0.01; versus sham‐FIO 2 0.3: 15.8±2.4 mL/kg per minute). The RQ of CA animals persistently decreased (CA‐FIO 2 1.0: 0.54±0.12 versus CA‐FIO 2 0.3: 0.68±0.05 versus sham‐FIO 2 0.3: 0.93±0.11, P<0.01 overall).Conclusions CA altered cellular metabolism resulting in increased VO 2 with normal VCO 2. Normal VCO 2 suggests that the postresuscitation Krebs cycle is operating at a presumably healthy rate. Increased VO 2 in the face of normal VCO 2 suggests a significant alteration in O2 utilization in postresuscitation. Several RQ values fell well outside the normally cited range of 0.7 to 1.0. Higher FIO 2 may increase VO 2, leading to even lower RQ values.

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Section: Discussionmentioning

confidence: 61%

Dissociated Oxygen Consumption and Carbon Dioxide Production in the Post–Cardiac Arrest Rat: A Novel Metabolic Phenotype

Shinozaki

Becker

Saeki³

et al. 2018

JAHA

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“…The objectives of postresuscitation care are to prevent recurring cardiac arrest and mitigate neurological damage 3. In the first 2 years of experience with the MRC protocol, we have demonstrated that this organized approach is feasible, with 73% of patients gaining access to the CCL within 6 hours and 59% receiving coronary revascularization.…”

Section: Discussionmentioning

confidence: 97%

“…Current guidelines emphasize the need for an organized approach to postresuscitation care, including transfer to centers capable of performing therapeutic hypothermia and PCI 3. The objectives of postresuscitation care are to prevent recurring cardiac arrest and mitigate neurological damage 3.…”

Section: Discussionmentioning

confidence: 99%

Early Access to the Cardiac Catheterization Laboratory for Patients Resuscitated From Cardiac Arrest Due to a Shockable Rhythm: The Minnesota Resuscitation Consortium Twin Cities Unified Protocol

García

Drexel

Bekwelem

et al. 2016

JAHA

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BackgroundIn 2013 the Minnesota Resuscitation Consortium developed an organized approach for the management of patients resuscitated from shockable rhythms to gain early access to the cardiac catheterization laboratory (CCL) in the metro area of Minneapolis‐St. Paul.Methods and ResultsEleven hospitals with 24/7 percutaneous coronary intervention capabilities agreed to provide early (within 6 hours of arrival at the Emergency Department) access to the CCL with the intention to perform coronary revascularization for outpatients who were successfully resuscitated from ventricular fibrillation/ventricular tachycardia arrest. Other inclusion criteria were age >18 and <76 and presumed cardiac etiology. Patients with other rhythms, known do not resuscitate/do not intubate, noncardiac etiology, significant bleeding, and terminal disease were excluded. The primary outcome was survival to hospital discharge with favorable neurological outcome. Patients (315 out of 331) who were resuscitated from VT/VF and transferred alive to the Emergency Department had complete medical records. Of those, 231 (73.3%) were taken to the CCL per the Minnesota Resuscitation Consortium protocol while 84 (26.6%) were not taken to the CCL (protocol deviations). Overall, 197 (63%) patients survived to hospital discharge with good neurological outcome (cerebral performance category of 1 or 2). Of the patients who followed the Minnesota Resuscitation Consortium protocol, 121 (52%) underwent percutaneous coronary intervention, and 15 (7%) underwent coronary artery bypass graft. In this group, 151 (65%) survived with good neurological outcome, whereas in the group that did not follow the Minnesota Resuscitation Consortium protocol, 46 (55%) survived with good neurological outcome (adjusted odds ratio: 1.99; [1.07–3.72], P=0.03).ConclusionsEarly access to the CCL after cardiac arrest due to a shockable rhythm in a selected group of patients is feasible in a large metropolitan area in the United States and is associated with a 65% survival rate to hospital discharge with a good neurological outcome.

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“…[9][10][11][12][13][14] Many of the treatments that are recommended in consensus guidelines and incorporated into protocols are, by necessity, based on low-quality evidence derived largely from observational studies. [15][16][17][18][19] For example, over the past decade it has become common practice to prevent/treat aggressively even relatively mild derangements in core body temperature, blood glucose levels, and serum sodium and hemoglobin concentrations. [20][21][22][23] With increasing use of electroencephalography, it has been recognized that many neurocritical care patients develop non-convulsive seizures, which most experts believe should be prevented or expeditiously diagnosed and treated.…”

Section: Résumémentioning

confidence: 99%

Declining mortality in neurocritical care patients: a cohort study in Southern Alberta over eleven years

Kramer

Zygun

2013

Can J Anesth/J Can Anesth

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Part 9: Post–Cardiac Arrest Care

Cited by 1,446 publications

References 287 publications

Dissociated Oxygen Consumption and Carbon Dioxide Production in the Post–Cardiac Arrest Rat: A Novel Metabolic Phenotype

Dissociated Oxygen Consumption and Carbon Dioxide Production in the Post–Cardiac Arrest Rat: A Novel Metabolic Phenotype

Early Access to the Cardiac Catheterization Laboratory for Patients Resuscitated From Cardiac Arrest Due to a Shockable Rhythm: The Minnesota Resuscitation Consortium Twin Cities Unified Protocol

Declining mortality in neurocritical care patients: a cohort study in Southern Alberta over eleven years

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