Education  |   July 2019
Postresuscitation Care after Out-of-hospital Cardiac Arrest: Clinical Update and Focus on Targeted Temperature Management
Author Notes
  • From the Research Center for Emergency Medicine, Department of Emergency Medicine and Department of Clinical Medicine, Aarhus University Hospital and Aarhus University, Aarhus, Denmark (H.K.); Department of Intensive Care, Clinique Universitaire de Bruxelles Erasme, Université Libre de Bruxelles, Brussels, Belgium (F.S.T.); Department of Anesthesiology, Intensive Care, and Pain Medicine, and Emergency Medicine and Services, Department of Emergency Medicine, Helsinki University Hospital and University of Helsinki, Helsinki, Finland (M.S.); Critical Care and Anaesthesiology Research Group, Stavanger University Hospital, Stavanger, Norway (E.S.); and Department of Clinical Medicine, University of Bergen, Bergen, Norway (E.S.).
  • This article is featured in “This Month in Anesthesiology,” page 1A.
    This article is featured in “This Month in Anesthesiology,” page 1A.×
  • Submitted for publication April 15, 2018. Accepted for publication February 20, 2019.
    Submitted for publication April 15, 2018. Accepted for publication February 20, 2019.×
  • Address correspondence to Dr. Kirkegaard: Research Center for Emergency Medicine, Palle Juul-Jensens Boulevard 161, J103, 8200 Aarhus N, Denmark. hanskirkegaard@dadlnet.dk. Information on purchasing reprints may be found at www.anesthesiology.org or on the masthead page at the beginning of this issue. Anesthesiology’s articles are made freely accessible to all readers, for personal use only, 6 months from the cover date of the issue.
Article Information
Education / Review Article / Cardiovascular Anesthesia / Central and Peripheral Nervous Systems / Critical Care / Infectious Disease / Respiratory System
Education   |   July 2019
Postresuscitation Care after Out-of-hospital Cardiac Arrest: Clinical Update and Focus on Targeted Temperature Management
Anesthesiology 7 2019, Vol.131, 186-208. doi:10.1097/ALN.0000000000002700
Anesthesiology 7 2019, Vol.131, 186-208. doi:10.1097/ALN.0000000000002700
Abstract

Out-of-hospital cardiac arrest is a major cause of mortality and morbidity worldwide. With the introduction of targeted temperature management more than a decade ago, postresuscitation care has attracted increased attention. In the present review, we discuss best practice hospital management of unconscious out-of-hospital cardiac arrest patients with a special focus on targeted temperature management. What is termed post–cardiac arrest syndrome strikes all organs and mandates access to specialized intensive care. All patients need a secured airway, and most patients need hemodynamic support with fluids and/or vasopressors. Furthermore, immediate coronary angiography and percutaneous coronary intervention, when indicated, has become an essential part of the postresuscitation treatment. Targeted temperature management with controlled sedation and mechanical ventilation is the most important neuroprotective strategy to take. Targeted temperature management should be initiated as quickly as possible, and according to international guidelines, it should be maintained at 32° to 36°C for at least 24 h, whereas rewarming should not increase more than 0.5°C per hour. However, uncertainty remains regarding targeted temperature management components, warranting further research into the optimal cooling rate, target temperature, duration of cooling, and the rewarming rate. Moreover, targeted temperature management is linked to some adverse effects. The risk of infection and bleeding is moderately increased, as is the risk of hypokalemia and magnesemia. Circulation needs to be monitored invasively and any deviances corrected in a timely fashion. Outcome prediction in the individual patient is challenging, and a self-fulfilling prophecy poses a real threat to early prognostication based on clinical assessment alone. Therefore, delayed and multimodal prognostication is now considered a key element of postresuscitation care. Finally, modern postresuscitation care can produce good outcomes in the majority of patients but requires major diagnostic and therapeutic resources and specific training. Hence, recent international guidelines strongly recommend the implementation of regional prehospital resuscitation systems with integrated and specialized cardiac arrest centers.