Articles: cardiac-arrest.
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Curr Opin Crit Care · Dec 2024
ReviewDoes targeted temperature management at 33 °C improve outcome after cardiac arrest?
Following successful resuscitation from cardiac arrest, a complex set of pathophysiologic processes are acutely triggered, leading to substantial morbidity and mortality. Postarrest management remains a major challenge to critical care providers, with few proven therapeutic strategies to improve outcomes. One therapy that has received substantial focus is the intentional lowering of core body temperature for a discrete period of time following resuscitation. In this review, we will discuss the key trials and other evidence surrounding TTM and present opposing arguments, one 'against' the use of postarrest TTM and another 'for' the use of this therapeutic approach. ⋯ There are several arguments for and against the use of TTM targeting 33 °C for alleviating brain injury after cardiac arrest. More studies are on the way that will hopefully provide more robust evidence and hopefully allow for consensus on this important topic.
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J. Cardiothorac. Vasc. Anesth. · Dec 2024
ReviewModernization of Cardiac Advanced Life Support: Role and Value of Cardiothoracic Anesthesiologist Intensivist in Post-Cardiac Surgery Arrest Resuscitation.
Cardiac arrest in the postoperative cardiac surgery patient requires a unique set of management skills that deviates from traditional cardiopulmonary resuscitation and Advanced Cardiovascular Life Support (ACLS). Cardiac Advanced Life Support (CALS) was first proposed in 2005 to address these intricacies. The hallmark of CALS is early chest reopening and internal cardiac massage within 5 minutes of the cardiac arrest in patients unresponsive to basic life support. ⋯ As such, we have proposed a modified CALS approach to (1) adapt to a newer generation of cardiac surgery patients and (2) incorporate advanced resuscitative techniques. These include rescue-focused cardiac ultrasound to aid in the early identification of underlying pathology and guide resuscitation and early institution of extracorporeal cardiopulmonary resuscitation instead of chest reopening. While these therapies are not immediately available in all cardiac surgery centers, we hope this creates a framework to revise guidelines to include these recommendations to improve outcomes and how cardiac anesthesiologist intensivists' evolving role can aid resuscitation.
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Emerg Med Australas · Dec 2024
ReviewReview article: Back to life from being declared dead in the Resus Bay: An integrative review of the phenomenon of autoresuscitation and learning for ED.
This is a literature review of ED autoresuscitation. The impetus for this review was a case which revealed a lack of understanding about Lazarus syndrome among ED staff. The primary objective was to see the proportion of cases who survived neurologically intact to discharge and the time frame when this occurred after death had been declared. ⋯ Under-reporting of autoresuscitation is suspected because of fears of blame. Passive monitoring for 10 min after resuscitation is ceased, is recommended. There is need for more data on this phenomenon to help inform further research on the topic.
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Extracorporeal cardiopulmonary resuscitation (ECPR) for refractory in-hospital cardiac arrest has been associated with improved survival compared with conventional cardiopulmonary resuscitation (CPR). Perioperative patients represent a unique of the inpatient population. This study aims to describe and analyze the characteristics and outcomes of patients who received ECPR for perioperative cardiac arrest (POCA). ⋯ The use of ECPR for adults with POCA can be associated with excellent survival with neurologically favorable outcomes in carefully selected patients. Longer CPR time, higher lactate levels, and lower pH were associated with increased mortality. Given the small sample size, no other prognostic factors were identified, though certain trends were detected between survival groups.