The influence of induced hypothermia and delayed prognostication on the mode of death after cardiac arrest.
TL;DR: Following induced hypothermia and delayed neurological prognostication, brain injury remains the main cause of death after CA and most patients with a poor prognosis statement died within 2 weeks.
About: This article is published in Resuscitation.The article was published on 2013-03-01. It has received 282 citations till now. The article focuses on the topics: Cause of death & Intensive care.
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Heart of England NHS Foundation Trust1, University of Warwick2, University of Helsinki3, Oslo University Hospital4, Ghent University5, University of Antwerp6, Innsbruck Medical University7, Mario Negri Institute for Pharmacological Research8, Southmead Hospital9, The Catholic University of America10, Imperial College Healthcare11, Royal United Hospital12, Imperial College London13, University of Bern14
TL;DR: This chapter contains guidance on the techniques used during the initial resuscitation of an adult cardiac arrest victim and the use of an automated external defibrillator (AED).
1,104 citations
TL;DR: In this paper, the authors present a review of the state of the art in the field of anaesthesia and intensive care medicine at the University of Oslo and the Norwegian Department of Anesthesia and Intensive Care Medicine at the Norwegian National Institute of Emergencies and Critical Care.
849 citations
TL;DR: This executive summary provides the essential treatment algorithms for the resuscitation of children and adults and highlights the main guideline changes since 2010.
767 citations
TL;DR: These post-resuscitation care guidelines, which are based on the 2015 International Consensus on Cardiopulmonary Resuscitation Science with Treatment Recommendations, place greater emphasis on rehabilitation after survival from a cardiac arrest.
Abstract: The European Resuscitation Council (ERC) and the European Society of Intensive Care Medicine (ESICM) have collaborated to produce these post-resuscitation 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.
588 citations
TL;DR: Mortality from post-CA shock and brain injury share similar risk factors, which are related to the quality of the rescue process, and bystander cardiopulmonary resuscitation (CPR) decreased the risk of death from neurological injury.
Abstract: Brain injury is well established as a cause of early mortality after out-of-hospital cardiac arrest (OHCA), but postresuscitation shock also contributes to these deaths. This study aims to describe the respective incidence, risk factors, and relation to mortality of post-cardiac arrest (CA) shock and brain injury. Retrospective analysis of an observational cohort. 24-bed medical intensive care unit (ICU) in a French university hospital. All consecutive patients admitted following OHCA were considered for analysis. Post-CA shock was defined as a need for infusion of vasoactive drugs after resuscitation. Death related to brain injury included brain death and care withdrawal for poor neurological evolution. None. Between 2000 and 2009, 1,152 patients were admitted after OHCA. Post-CA shock occurred in 789 (68 %) patients. Independent factors associated with its onset were high blood lactate and creatinine levels at ICU admission. During the ICU stay, 269 (34.8 %) patients died from post-CA shock and 499 (65.2 %) from neurological injury. Age, raised blood lactate and creatinine values, and time from collapse to restoration of spontaneous circulation increased the risk of ICU mortality from both shock and brain injury, whereas a shockable rhythm was associated with reduced risk of death from these causes. Finally, bystander cardiopulmonary resuscitation (CPR) decreased the risk of death from neurological injury. Brain injury accounts for the majority of deaths, but post-CA shock affects more than two-thirds of OHCA patients. Mortality from post-CA shock and brain injury share similar risk factors, which are related to the quality of the rescue process.
442 citations
Cites background from "The influence of induced hypothermi..."
...A few studies have specifically focused on mode of death after CA [3, 15]....
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...A more recent Swedish study (162 OHCA, 47 % survival rate) reported three modes of death: brain injury (71 % of nonsurvivors), shock (16 %), and miscellaneous etiology (13 %) [15]....
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...Moreover, we did not perform autopsy, which could have clarified some diagnoses [15]....
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TL;DR: In this article, a five-point scale is described, which includes death, persistent vegetative state, severe disability, moderate disability, and good recovery, and duration as well as intensity of disability should be included in an index of ill-health.
6,952 citations
TL;DR: This randomized, controlled trial compared the effects of moderate hypothermia and normothermia in patients who remained unconscious after resuscitation from out-of-hospital cardiac arrest to survive to hospital discharge and be discharged to home or to a rehabilitation facility.
Abstract: Background Cardiac arrest outside the hospital is common and has a poor outcome. Studies in laboratory animals suggest that hypothermia induced shortly after the restoration of spontaneous circulation may improve neurologic outcome, but there have been no conclusive studies in humans. In a randomized, controlled trial, we compared the effects of moderate hypothermia and normothermia in patients who remained unconscious after resuscitation from out-of-hospital cardiac arrest. Methods The study subjects were 77 patients who were randomly assigned to treatment with hypothermia (with the core body temperature reduced to 33°C within 2 hours after the return of spontaneous circulation and maintained at that temperature for 12 hours) or normothermia. The primary outcome measure was survival to hospital discharge with sufficiently good neurologic function to be discharged to home or to a rehabilitation facility. Results The demographic characteristics of the patients were similar in the hypothermia and normotherm...
4,631 citations
TL;DR: In patients who have been successfully resuscitated after cardiac arrest due to ventricular fibrillation, therapeutic mild hypothermia increased the rate of a favorable neurologic outcome and reduced mortality.
Abstract: Background: Cardiac arrest with widespread cerebral ischemia frequently leads to severe neurologic impairment. We studied whether mild systemic hypothermia increases the rate of neurologic recovery after resuscitation from cardiac arrest due to ventricular fibrillation. Methods: In this multicenter trial with blinded assessment of the outcome, patients who had been resuscitated after cardiac arrest due to ventricular fibrillation were randomly assigned to undergo therapeutic hypothermia (target temperature, 32°C to 34°C, measured in the bladder) over a period of 24 hours or to receive standard treatment with normothermia. The primary end point was a favorable neurologic outcome within six months after cardiac arrest; secondary end points were mortality within six months and the rate of complications within seven days. Results: Seventy-five of the 136 patients in the hypothermia group for whom data were available (55 percent) had a favorable neurologic outcome (cerebral-performance category, 1 [good recovery] or 2 [moderate disability]), as compared with 54 of 137 (39 percent) in the normothermia group (risk ratio, 1.40; 95 percent confidence interval, 1.08 to 1.81). Mortality at six months was 41 percent in the hypothermia group (56 of 137 patients died), as compared with 55 percent in the normothermia group (76 of 138 patients; risk ratio, 0.74; 95 percent confidence interval, 0.58 to 0.95). The complication rate did not differ significantly between the two groups. Conclusions: In patients who have been successfully resuscitated after cardiac arrest due to ventricular fibrillation, therapeutic mild hypothermia increased the rate of a favorable neurologic outcome and reduced mortality.
4,493 citations
TL;DR: The goal of immediate post-cardiac arrest care is to optimize systemic perfusion, restore metabolic homeostasis, and support organ system function to increase the likelihood of intact neurological survival.
Abstract: There is increasing recognition that systematic post–cardiac arrest care after return of spontaneous circulation (ROSC) can improve the likelihood of patient survival with good quality of life. This is based in part on the publication of results of randomized controlled clinical trials as well as a description of the post–cardiac arrest syndrome. 1–3 Post–cardiac arrest care has significant potential to reduce early mortality caused by hemodynamic instability and later morbidity and mortality from multiorgan failure and brain injury. 3,4 This section summarizes our evolving understanding of the hemodynamic, neurological, and metabolic abnormalities encountered in patients who are initially resuscitated from cardiac arrest. The initial objectives of post–cardiac arrest care are to ● Optimize cardiopulmonary function and vital organ perfusion. ● After out-of-hospital cardiac arrest, transport patient to an appropriate hospital with a comprehensive post–cardiac arrest treatment system of care that includes acute coronary interventions, neurological care, goal-directed critical care, and hypothermia. ● Transport the in-hospital post–cardiac arrest patient to an appropriate critical-care unit capable of providing comprehensive post–cardiac arrest care. ● Try to identify and treat the precipitating causes of the arrest and prevent recurrent arrest.
2,590 citations