Best practice & research. Clinical anaesthesiology
-
Best Pract Res Clin Anaesthesiol · Dec 2015
ReviewVentilation and gas exchange management after cardiac arrest.
For several decades, physicians had integrated several interventions aiming to improve the outcomes in post-cardiac arrest patients. However, the mortality rate after cardiac arrest is still as high as 50%. Post-cardiac arrest syndrome is associated with high morbidity and mortality due to not only poor neurological outcome and cardiovascular failure but also respiratory dysfunction. ⋯ Furthermore, optimizing gas exchange by avoiding hypoxia and hyperoxia as well as maintaining normocarbia may improve neurological and survival outcome. Early multidisciplinary cardiac rehabilitation intervention is recommended. Minimally invasive monitoring techniques, that is, echocardiography, transpulmonary thermodilution method measuring extravascular lung water, as well as transcranial Doppler ultrasound, might be useful to improve appropriate management of post-cardiac arrest patients.
-
Best Pract Res Clin Anaesthesiol · Dec 2015
ReviewWhat is the proper target temperature for out-of-hospital cardiac arrest?
The implementation of target temperature management (TTM) or therapeutic hypothermia has been demonstrated in several major studies to be an effective neuroprotective strategy in postresuscitation care after cardiac arrest. Although several landmark studies found the promising results of lower targeted temperature (32-34 °C) in terms of survival and neurological outcomes, recent evidence showed no difference in either survival or long-term neurological outcome when compared with higher targeted temperature (36 °C). ⋯ Many questions are still debated about the exact protocol of TTM to be used, including whether temperature control is more beneficial than standard of care without active temperature control, the optimal cooling temperature, patient selection, and duration of cooling. The aim of this review article was to discuss the physiology of hypothermia, available cooling methods, and current evidence about the optimal target temperature and timing of hypothermia.
-
Cardiac arrest (CA) often results in hemodynamic and metabolic compromise with associated poor prognosis. Therapeutic hypothermia (TH) has become the standard of care for CA survivors, decreasing reperfusion injury and intercellular acid-base disturbances, with improved neurologic outcomes. These benefits are realized despite a mild acidosis that can potentially occur during TH. ⋯ Bicarbonate should be used only in case of severe acidosis and as a continuous infusion. The blood gas samples are usually warmed to 37 °C before analysis; hence, it is worth noting that the blood gas values are temperature dependent. Therefore, a calculated correction for values may be necessary.
-
Sudden cardiac arrest is a complex, life-threatening event involving a multidisciplinary approach. Despite the use of conventional cardiopulmonary resuscitation, survival rate continues to be low for both in-hospital and out-of-hospital cardiac arrest. ⋯ Extracorporeal circulation ensures an adequate blood flow, to perform diagnostic and therapeutic interventions even before a return of spontaneous circulation is achieved and to rest the heart by unloading the ventricle while ensuring myocardial perfusion after return of spontaneous circulation. This study reviews the rational, indications, evidence and management of extracorporeal support for cardiac arrest.
-
Best Pract Res Clin Anaesthesiol · Dec 2015
ReviewAnalgesia, sedation, and neuromuscular blockade during targeted temperature management after cardiac arrest.
The approach to sedation, analgesia, and neuromuscular blockade during targeted temperature management (TTM) remains largely unstudied, forcing clinicians to adapt previous research from other patient environments. During TTM, very little data guide drug selection, doses, and specific therapeutic goals. ⋯ We review the potential therapeutic goals for sedation, analgesia, and neuromuscular blockade during TTM; the adverse events associated with that treatment; data suggesting that TTM and organ dysfunction impair drug metabolism; and controversies and potential benefits of specific monitoring. We also highlight the areas needing better research to guide our therapy.