Curr Treat Option Ne
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Therapeutic hypothermia (TH), which prevents and ameliorates the cascade of secondary neurologic injury after the return of spontaneous circulation, is the most effective neuroprotective therapy for encephalopathic survivors of cardiac arrest. Despite the compelling efficacy of TH, most patients who survive cardiac arrest long enough to be hospitalized will nonetheless suffer a poor neurologic outcome. Attention to the details of therapy and an integrated approach involving emergency medicine, neurology, cardiology, critical care medicine, and palliative care are likely to yield the best results. ⋯ In the intensive care unit, cerebral perfusion must be optimized, metabolic homeostasis achieved, and neuromonitoring used during the dangerous decooling phase. Cardiac arrest is always a life-altering event for patients and their families. Even after cardiac arrest survivors have been stabilized and treated, physicians must recogonize and embrace their role in facilitating a variety of difficult transitions: to organ donation, end-of-life care, nursing or rehabilitation placement, or home.
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Malignant middle cerebral artery infarction is associated with up to 80% mortality due to ischemic edema and brain herniation. No medical therapy has proven its efficacy in efficiently and durably reducing brain edema and improving patients' outcome. Decompressive surgery by a large hemicraniectomy with durotomy has been suggested as a life-saving emergency procedure. ⋯ Recently the results of a pooled analysis of three European randomized trials (DECIMAL, DESTINY, and HAMLET) of early (
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Successful critical care management of patients with aneurysmal subarachnoid hemorrhage (SAH) requires a thorough understanding of the disease and its complications and a familiarity with modern multimodality neuromonitoring technology. This article reviews the natural history of aneurysmal SAH and strategies for disease management in the acute setting, including available tools for monitoring brain function. Intensive care management of patients with SAH focuses on prevention of further neurologic injury. ⋯ There is increasing awareness of extracerebral complications, including electrolyte disturbances (eg, cerebral salt wasting) and cardiac dysfunction. Prompt recognition and treatment of these disorders maximizes the odds of a good functional outcome. Technologic advances hold the promise of improved detection and treatment of secondary neurologic insults.