Majority Of Cardiac Arrest Research Articles

53. Improved outcome of cardio-pulmonary arrest in post-operative cardiac children resuscitated in critical care setup

Background/Aim Outcome of cardio-pulmonary resuscitation in post-operative cardiac children in ICU setup has changed markedly in the last 20 years. The purpose of the study is to look for the current causes, practice and outcome of CPR in post-operative children within PCICU setup. Methods we conducted retrospective review study of all children who had cardio pulmonary arrest (CPA) after cardiac surgery in PCICU of KAMC during 2012–2013. We looked for the causes, circumstances, duration of resuscitation and time to return of spontaneous circulation (ROSC) after arrest and outcome. Results During this study, of the 758 post-operative children admitted to the PCICU. 15 patients (2%) had 19 episodes of Cardio-Pulmonary Arrests. 9/19 (47%) arrests were due to arrhythmia. The age of the patients ranged from 15 day to 14 years (median of 10 months). Cardiac arrest occurred during procedure in 5 cases (26%). One Patient (7%) had open cardiac message. Median arrests time occurred on the 5th post-operative days. Of the 19 arrests episodes in 15 patients 16/19 (84%) were successfully resuscitated to ROSC and 12/15 patients (80%) survived to discharge from hospital with average follow up of 5.8 ± 1.25 months. Conclusions The current outcome of cardio-pulmonary arrest in post-operative cardiac children has improved. Majority of cardiac arrest were successfully resuscitated with ROSC and 80% survived to discharge. The current result reflects significant improvement in the reported outcome of children who had cardio-pulmonary arrest in post-operative cardiac children in PCICU setup.

Prognostication of outcome after cardiac arrest and targeted temperature management

The vast majority of cardiac arrest (CA) survivors remain comatose at hospital arrival. Around one-half of these patients suffer from severe hypoxic encephalopathy leading to death or unresponsive wakefulness. Early outcome prognostication may reduce futile intensive care and suffering for next of kin. Several early prognostic markers have shown high positive predictive value for poor outcome in patients treated at normothermia, but results may be altered by targeted temperature management (TTM). Most prominently, absent motor response to painful stimuli 3 days after CA and a serum concentration of neuron-specific enolase (NSE) above 33 ng/ml do not predict poor outcome reliably in these patients [1,2]. Sedation during TTM is a relevant confounder for motor response and corneal reflexes [3]. Bilaterally absent pupillary light reaction 3 days after CA is a reliable predictor of poor outcome (sensitivity 20%) [1]. Eye diseases and medication are potential confounders. A threshold for poor outcome prediction by NSE has not been established after TTM. Above a level of 80 to 100 ng/ml 72 hours after CA good outcome has rarely been reported. The NSE levels may vary with different test kits, and NSE producing tumors, acute brain diseases and severe hematological diseases/hemolysis are confounders. Bilateral absence of cortical median nerve SSEP remains a reliable predictor, but single cases with recovery were reported [4] and inter-rater reliability is not perfect. Preserved spinal SSEP and low cortical noise levels are important prerequisites. The sensitivity of absent SSEP for poor outcome prediction is around 40% [1]. EEG can be a valuable predictive tool when interpreted by experienced neurophysiologists and indicates (subclinical) status epilepticus [5]. The influence of medication on EEG needs to be considered. Recently, a revised EEG classification has been proposed [6]. A reduced contrast between gray and white matter in brain computed tomography is associated with poor outcome. It can be quantified as gray–white-matter ratio and values below 1.1 predict poor outcome with high specificity [7]. Additional studies are needed to establish this threshold more firmly. MRI emerges as a prognostic parameter because of high spatial resolution and high sensitivity for cytotoxic brain edema with DWI/ADC imaging [8]. However, access is limited and quantification of early changes needs to be established in larger cohorts. To date, most authors argue for a multiparameter prognostication approach including repeated neurological examination, SSEP, NSE, EEG and imaging (CT or MRI) combined with a waiting period for potential recovery of several days after cardiac arrest.

Syndrome post-arrêt cardiaque : aspects physiopathologiques, cliniques et thérapeutiques

ObjectiveThis review aims at providing an update on post-cardiac arrest syndrome, from pathophysiology to treatment. Data sourcesMedline database. Data extractionAll data on pathophysiology, clinical manifestations and therapeutic management, with focus on the publications of the 5 last years. Data synthesisCare of the patients after cardiac arrest is a medical challenge, in face of “post-cardiac arrest syndrome”, which culminates into multi-organ failure. This syndrome mimics sepsis-related dysfunctions, with all clinical and biological manifestations related to the phenomenon of global ischemia-reperfusion. Acute cardiocirculatory dysfunction is usually controlled through pharmacological and mechanical support. Meanwhile, as a majority of cardiac arrest is related to myocardial infarction, early angiographic exploration should then be discussed when there is no obvious extracardiac cause, percutaneous coronary revascularization being associated with improved short and long-term prognosis. Therapeutic hypothermia is the cornerstone of neuroprotective armamentarium, beyond hemodynamic stabilization and metabolic maintenance. ConclusionIf ongoing evaluations should shed light on potential efficiency of new therapeutic drugs, a multidisciplinary approach of the post-cardiac arrest syndrome in expertise centre is essential.