Current opinion in critical care
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Curr Opin Crit Care · Jun 2014
ReviewThe impact of oxygen and carbon dioxide management on outcome after cardiac arrest.
To describe the impact of oxygen and carbon dioxide management on patient outcomes following cardiac arrest. ⋯ Current data for oxygen and carbon dioxide management following resuscitation suggest that hyperoxia and hypocapnia may be injurious and should be avoided, and that mild hypercapnia may increase the likelihood of discharge home amongst survivors. Such data should be viewed as hypothesis generating. Randomized controlled trials have commenced to clarify the safety, feasibility and efficacy of targeting different oxygen and carbon dioxide tensions following cardiac arrest.
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The quality of cardiopulmonary resuscitation (CPR) impacts on outcome after cardiac arrest. This review will explore the factors that contribute to high-quality CPR and the metrics that can be used to monitor performance. ⋯ There is evidence for increasing survival rates following out-of-hospital cardiac arrest and this is associated with increasing rates of bystander CPR. The quality of CPR provided by healthcare professionals can be improved with real-time feedback devices. The components of high-quality CPR and the metrics that can be measured and fed back to healthcare professionals have been defined by expert consensus. In the future, real-time feedback based on the physiological responses to CPR may prove more effective.
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Despite decades of advances in prehospital and in-hospital medical care, patients with out-of-hospital cardiac arrest continue to have poor neurologic and cardiac function following otherwise successful resuscitation. This review examines the mechanisms and therapeutic strategies currently under development to activate the post-conditioning pathways and thereby improve survival and function. ⋯ Detailed knowledge of the RISK and SAFE pathways can be used for further drug development. Human studies are now underway to test some of these strategies, but further clinical trials are necessary to translate these therapies to clinical practice.
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To discuss the role of extracorporeal membrane oxygenation (ECMO) in patients with cardiac arrest. ⋯ This review highlights that ECPR is feasible for both IHCA and OHCA. In the recent series, the outcome of ECPR in IHCA is satisfactory, with survival rates good with neurologic outcome reaching the 40-50% range. All series converge in highlighting that time from cardiac arrest to ECMO flow is a critical determinant of outcome, with survival rates of 50% when initiated within 30 min of IHCA, 30% between 30 and 60 min, and 18% after 60 min. Results of ECPR in OHCA are more challenging. Recent series suggest that good outcome can be obtained in 15-20% of the patients, provided that time from arrest to ECMO is shorter than 60 min. Duration of cardiac arrest seems to be more important than location of cardiac arrest. ECPR thus seems to be a valuable option in selected cases.