Post resuscitation care

Nolan, P J; Soar, Jasmeet; Cariou, Alain; Cronberg, Tobias; Moulaert, Véronique; Deakin, Charles D.; Böttiger, Bernd W.; Friberg, Hans; Sunde, Kjetil; Sandroni, Claudio

doi:10.1007/s10049-017-0331-5

Cited by 12 publications

(8 citation statements)

References 638 publications

(389 reference statements)

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“…Hemodynamic instability contributes to increased mortality and secondary brain injury (6)(7)(8). Blood pressure management with vasopressors aims to maintain sufficient cerebral perfusion and avoid secondary ischemia as cerebral blood flow autoregulation is impaired following cerebral ischemia (9)(10)(11).…”

Section: Introductionmentioning

confidence: 99%

“…Current international guidelines recommend the avoidance of having a mean arterial blood pressure (MAP) below 65 mmHg. Vasopressors are recommended to counteract lower values, but evidence supporting a specific MAP target is lacking (11,12). Hypotension and increased vasopressor requirements were previously found to be associated with increased mortality and poor neurological outcomes (13,14).…”

Section: Introductionmentioning

confidence: 99%

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Survival, but not the severity of hypoxic–ischemic encephalopathy, is associated with higher mean arterial blood pressure after cardiac arrest: a retrospective cohort study

Preuß,

Multmeier,

Stenzel

et al. 2024

Front. Cardiovasc. Med.

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BackgroundThis study investigates the association between the mean arterial blood pressure (MAP), vasopressor requirement, and severity of hypoxic–ischemic encephalopathy (HIE) after cardiac arrest (CA).MethodsBetween 2008 and 2017, we retrospectively analyzed the MAP 200 h after CA and quantified the vasopressor requirements using the cumulative vasopressor index (CVI). Through a postmortem brain autopsy in non-survivors, the severity of the HIE was histopathologically dichotomized into no/mild and severe HIE. In survivors, we dichotomized the severity of HIE into no/mild cerebral performance category (CPC) 1 and severe HIE (CPC 4). We investigated the regain of consciousness, causes of death, and 5-day survival as hemodynamic confounders.ResultsAmong the 350 non-survivors, 117 had histopathologically severe HIE while 233 had no/mild HIE, without differences observed in the MAP (73.1 vs. 72.0 mmHg, pgroup = 0.639). Compared to the non-survivors, 211 patients with CPC 1 and 57 patients with CPC 4 had higher MAP values that showed significant, but clinically non-relevant, MAP differences (81.2 vs. 82.3 mmHg, pgroup < 0.001). The no/mild HIE non-survivors (n = 54), who regained consciousness before death, had higher MAP values compared to those with no/mild HIE (n = 179), who remained persistently comatose (74.7 vs. 69.3 mmHg, pgroup < 0.001). The no/mild HIE non-survivors, who regained consciousness, required fewer vasopressors (CVI 2.1 vs. 3.6, pgroup < 0.001). Independent of the severity of HIE, the survivors were weaned faster from vasopressors (CVI 1.0).ConclusionsAlthough a higher MAP was associated with survival in CA patients treated with a vasopressor-supported MAP target above 65 mmHg, the severity of HIE was not. Awakening from coma was associated with less vasopressor requirements. Our results provide no evidence for a MAP target above the current guideline recommendations that can decrease the severity of HIE.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Survival, but not the severity of hypoxic–ischemic encephalopathy, is associated with higher mean arterial blood pressure after cardiac arrest: a retrospective cohort study

Preuß,

Multmeier,

Stenzel

et al. 2024

Front. Cardiovasc. Med.

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“…12 These findings are consistent with international guidelines that a normal PaCO2 should be targeted during post-resuscitation care. 13,14 Data from existing randomized-controlledtrials targeting different PaCO2 levels in adult patients after cardiac arrest are sparse. 15,16 Most of the observational studies are limited by their use of arbitrary cut-points to define an optimal PaCO2, analysis of PaCO2 using data from one single time point or over a limited period of time, and assuming PaCO2 is linearly associated with survival.…”

Section: Introductionmentioning

confidence: 99%

Arterial carbon dioxide tension has a non-linear association with survival after out-of-hospital cardiac arrest: A multicentre observational study

et al. 2021

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“…Coronary thrombosis and pulmonary embolism are also common causes of cardiac arrest [10,11]. Furthermore, current guidelines recognize thrombosis as a potential (and reversible) cause of cardiac arrest [12]. Moreover, hypothermia and hypercoagulability are common pathophysiological processes following cardiac arrest [13,14].…”

Section: Introductionmentioning

confidence: 99%

Can Heparin Improve Clinical Outcomes in Cardiac Arrest? A Retrospective Cohort Study from the EICU Collaborative Research Database

Gao

Zhang

2021

Preprint

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Background: Studies indicate that heparin can improve survival in patients with out-of-hospital cardiac arrest. Thus, we aimed to investigate the effect of heparin on hospitalized patients with cardiac arrest.Methods: Clinical data of cardiac arrest patients from the eICU Collaborative Research Database V2.0 were retrospectively analyzed. We compared neurological prognosis and primary outcomes in a heparin group that received unfractionated heparin or low molecular weight heparin with a non-heparin group. Additionally, we compared the two heparin sub-groups. Results: After propensity score matching, there were 673 patients in the heparin group and 1346 patients in the non-heparin group. The Glasgow Coma Scale score was significantly better in the heparin group (P<0.05). There were no significant differences in terms of spontaneous respiratory function recovery, dementia, or vegetative state between the two groups (P>0.05). Intensive care unit (ICU) mortality and hospital mortality rates were significantly lower in the heparin group (P<0.05). The duration of mechanical ventilation, length of stay in ICU, and length of stay in hospital were significantly longer in the heparin group (P<0.05). Median survival time was significantly longer in the heparin group (P<0.001). In the comparison of patients who received unfractionated heparin and low molecular weight heparin (267 in each group), there were no significant differences in Glasgow Coma Scale score, ICU mortality, hospital mortality, or median survival time between the two groups (P>0.05).Conclusions: Heparin administration may be beneficial in reducing the mortality rate and prolonging the survival time of in-hospital patients with cardiac arrest. It may also improve the prognosis of neurological function to a certain extent. Outcomes were not significantly different between patients who received unfractionated heparin and those who received low molecular weight heparin.

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Post resuscitation care

Cited by 12 publications

References 638 publications

Survival, but not the severity of hypoxic–ischemic encephalopathy, is associated with higher mean arterial blood pressure after cardiac arrest: a retrospective cohort study

Survival, but not the severity of hypoxic–ischemic encephalopathy, is associated with higher mean arterial blood pressure after cardiac arrest: a retrospective cohort study

Arterial carbon dioxide tension has a non-linear association with survival after out-of-hospital cardiac arrest: A multicentre observational study

Can Heparin Improve Clinical Outcomes in Cardiac Arrest? A Retrospective Cohort Study from the EICU Collaborative Research Database

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