Chapter 22 - Post-resuscitation care

Summary

Current theories on the concept of a post-resuscitation syndrome describe the development of a systemic inflammatory response/sepsis following resuscitation from cardiac arrest. Critical care treatments during the post-resuscitation phase should focus on correcting hypoxia and hypercarbia, optimizing organ perfusion, identifying and treating the underlying cause of the cardiac arrest and optimizing neurological outcomes. Several randomized controlled trials and a meta-analysis have shown that therapeutic hypothermia is associated with improved survival and neurological outcome in initially comatose survivors of cardiac arrest. Observational studies in cardiac arrest survivors have shown that hyperglycaemia after return of spontaneous circulation is associated with an adverse outcome. Myocardial dysfunction is common after cardiac arrest and usually starts to improve within 72 hours after return of spontaneous circulation. Acidosis and control of seizures are explained in this chapter. The ability to predict the likely neurological outcome of a patient following admission to critical care is important.