Top Things to Know: The Critical Care Management of Patients After Cardiac Arrest

Published: November 28, 2023

Cardiac arrest (CA) affects over 600 000 people in the United States annually, with a worldwide annual incidence of 30 to 97 individuals per 100 000 population. Intensive care management of CA survivors is critically important as it impacts survival and neurological outcomes.
The critical care management of patients after cardiac arrest is limited by the lack of high-quality clinical studies and a resultant lack of high-certainty evidence, leading to potential uncertainty and variability in clinical management. Existing Guidelines are thus limited in addressing these topics.
The American Heart Association Emergency and Cardiovascular Care Committee and the Neurocritical Care Society collaborated to address this gap by convening an expert consensus panel and conference focusing on the comprehensive intensive care unit (ICU) management of patients after cardiac arrest.
Neurological management in the ICU focuses on the diagnosis and management of intracranial hypertension and seizures and findings on the ictal-interictal continuum. A new nomenclature for different types of myoclonus is defined.
Neurological management also addresses analgesic and sedative use and defines important research gaps in monitoring and treating cerebral edema and intracranial hypertension.
Cardiac management focuses on hemodynamic measurements and augmentation, mechanical circulatory support, and additional considerations for timing and appropriateness of cardiac catheterization.
Pulmonary management addresses oxygenation and ventilation approaches and targets and their interplay with other organ systems.
Other organ systems are also addressed, with a unique focus on the complex interplay of different organ systems in the management of patients with post-cardiac arrest multi-organ dysfunction.
General critical care management focuses on supporting patients and families, structuring care updates and addressing uncertainty, supporting dedicated training for clinicians involved in goals-of-care discussions, and collecting and evaluating outcomes. A section dedicated to neurological evaluation of patients who are comatose after cardiac arrest is highlighted.
This collaborative statement brought together a diverse group with expertise in post-CA care to identify current knowledge gaps and provide guidance about care in topics where research and existing guidelines were not able to provide high certainty of evidence.

View the summary for Critical Care Management of Patients After Cardiac Arrest

Citation

Hirsch KG, Abella BS, Amorim E, Bader MK, Barletta JF, Berg K, Callaway CW, Friberg H, Gilmore EJ, Greer DM, Kern KB, Livesay S, May TL, Neumar RW, Nolan JP, Oddo M, Peberdy MA, Poloyac SM, Seder D, Taccone FS, Uzendu A, Walsh B, Zimmerman JL, Geocadin RG; on behalf of the American Heart Association and Neurocritical Care Society. Critical care management of patients after cardiac arrest: ascientific statement from the American Heart Association and Neurocritical Care Society. Circulation. Published online November 28, 2023. doi: 10.1161/CIR.0000000000001163