Saturday, July 28, 2012

Post-Cardiac Arrest Syndrome



I will be compiling material for therapeutic hypothermia but I believe to fully understand the benefit it needs to be defined as to why it is needed, and further I will try to figure out if there is any benefit if induced in the prehospital environment.

Post-Cardiac Arrest Syndrome
After a patient has return of spontaneous circulation, the resuscitation has not ended. In reality it has only begun. In reality the term "post-resuscitation" would mean that regain of a pulse is the endpoint. Years ago that may have been the case. Patients were admitted to an icu bed where the pathological process of the post arrest syndrome would continue to evolve and be the patients demise. Now return of spontaneous circulation is the beginning of resuscitation.

Over the past half-century great advances have been made to improve the rate of ROSC but long term survival has not improved and the data is out there.

In order to get off of the subject I will conclude. The point to be taken here is that there is no post resuscitation syndrome. That would mean the resuscitation has stopped. This is not the endpoint. We continue to resuscitate the patient after ROSC.

What care needs to be provided after ROSC.
Our goal for a patient in cardiac arrest Is NOT to only regain a pulse but to have a increase in a rate of survival that leads to an increase of hospital discharge. We see that with the emphasis of early defibrillation and continuous cpr in the new aha guidelines. Maybe more is not always better. I say that because what use to work, i.e. tons of epi and endotracheal intubation is slowly weaning its way out for cardiac arrest care. This is admitted and documented.

Read this excerpt from the aha journals

"Survival from these cardiac arrest rhythms requires both basic life support (BLS) and a system of advanced cardiovascular life support (ACLS) with integrated post–cardiac arrest care. The foundation of successful ACLS is high-quality CPR, and, for VF/pulseless VT, attempted defibrillation within minutes of collapse. For victims of witnessed VF arrest, early CPR and rapid defibrillation can significantly increase the chance for survival to hospital discharge.In comparison, other ACLS therapies such as some medications and advanced airways, although associated with an increased rate of ROSC, have not been shown to increase the rate of survival to hospital discharge. The majority of clinical trials testing these ACLS interventions, however, preceded the recently renewed emphasis on high-quality CPR and advances in post–cardiac arrest care (see Part 9: “Post–Cardiac Arrest Care”). Therefore, it remains to be determined if improved rates of ROSC achieved with ACLS interventions might better translate into improved long-term outcomes when combined with higher-quality CPR and post–cardiac arrest interventions such as therapeutic hypothermia and early percutaneous coronary intervention (PCI)."[1]




[1]http://circ.ahajournals.org/content/122/18_suppl_3/S729.full

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