Cardiac Arrest in the Intensive Care Unit

AbstractPulseless cardiac arrest, defined as the cessation of cardiac mechanical activity, determined by unresponsiveness, apneoa, and the absence of a palpable central pulse, accounts for around one-twentieth of admissions to paediatric intensive care units, be they medical or exclusively cardiac. Such cardiac arrest is higher in children admitted to a cardiac as opposed to a paediatric intensive care unit, but the outcome of these patients is better, with just over two-fifths surviving when treated in the cardiac intensive care unit, versus between one-sixth and one-quarter of those admitted to paediatric intensive care units. Children who receive chest compressions for bradycardia with pulses have a significantly higher rate of survival to discharge, at 60%, than do those presenting with pulseless cardiac arrest, with only 27% surviving to discharge. This suggests that early resuscitation before the patient becomes pulseless, along with early recognition and intervention, are likely to improve outcomes. Recently published reports of in-hospital cardiac arrests in children can be derived from the multi-centric National Registry of Cardiopulmonary Resuscitation provided by the American Heart Association. The population is heterogeneous, but most arrests occurred in children with progressive respiratory insufficiency, and/or progressive circulatory shock. During the past 4 years at the Children’s Hospital of Philadelphia, 3.1% of the average 1000 annual admissions to the cardiac intensive care unit have received cardiopulmonary resuscitation. Overall survival of those receiving cardiopulmonary resuscitation was 46%. Survival was better for those receiving cardiopulmonary resuscitation after cardiac surgery, at 53%, compared with survival of 33% for pre-operative or non-surgical patients undergoing resuscitation. Clearly there is room for improvement in outcomes from cardiac resuscitation in children with cardiac disease. In this review, therefore, we summarize the newest developments in paediatric resuscitation, with an expanded focus upon the unique challenges and importance of anticipatory care in infants and children with cardiac disease.

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Incidence and outcome from adult cardiac arrest occurring in the intensive care unit: A systematic review of the literature

Resuscitation ◽

10.1016/j.resuscitation.2013.12.027 ◽

2014 ◽

Vol 85 (4) ◽

pp. 472-479 ◽

Cited By ~ 22

Author(s):

Ilmar Efendijev ◽

Jouni Nurmi ◽

Maaret Castrén ◽

Markus B. Skrifvars

Keyword(s):

Systematic Review ◽

Intensive Care Unit ◽

Cardiac Arrest ◽

Intensive Care ◽

Review Of The Literature

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Outcomes after extracorporeal cardiopulmonary resuscitation (ECPR) following refractory pediatric cardiac arrest in the intensive care unit

Resuscitation ◽

10.1016/j.resuscitation.2009.07.004 ◽

2009 ◽

Vol 80 (10) ◽

pp. 1124-1129 ◽

Cited By ~ 60

Author(s):

Parthak Prodhan ◽

Richard T. Fiser ◽

Umesh Dyamenahalli ◽

Jeffrey Gossett ◽

Michiaki Imamura ◽

...

Keyword(s):

Intensive Care Unit ◽

Cardiac Arrest ◽

Intensive Care ◽

Cardiopulmonary Resuscitation ◽

Extracorporeal Cardiopulmonary Resuscitation

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Cardiac Arrest in Infants After Congenital Heart Surgery

Circulation ◽

10.1161/circ.100.suppl_2.ii-194 ◽

1999 ◽

Vol 100 (suppl_2) ◽

Author(s):

John F. Rhodes ◽

Andrew D. Blaufox ◽

Howard S. Seiden ◽

Jeremy D. Asnes ◽

Ronda P. Gross ◽

...

Keyword(s):

Blood Pressure ◽

Intensive Care Unit ◽

Cardiac Arrest ◽

Intensive Care ◽

Pediatric Intensive Care Unit ◽

Congenital Heart ◽

Heart Surgery ◽

Pediatric Intensive Care ◽

Congenital Heart Surgery ◽

Inotropic Support

Background —The survival rate to discharge after a cardiac arrest in a patient in the pediatric intensive care unit is reported to be as low as 7%. The survival rates and markers for survival strictly regarding infants with cardiac arrest after congenital heart surgery are unknown. Methods and Results —Infants in our pediatric cardiac intensive care unit database were identified who had a postoperative cardiac arrest between January 1994 and June 1998. Parameters from the perioperative, prearrest, and resuscitation periods were analyzed for these patients. Comparisons were made between survivors and nonsurvivors. Of 575 infants who underwent congenital heart surgery, 34 (6%) sustained a documented cardiac arrest; of these, 14 (41%) survived to discharge. Perioperative parameters, ventricular physiology, and primary rhythm at the time of arrest did not influence outcome. Prearrest blood pressure was lower in nonsurvivors than in survivors ( P <0.001). A high level of inotropic support prearrest was associated with death ( P =0.06). Survivors had a shorter duration of resuscitation ( P <0.001) and higher minimal arterial pH ( P <0.02) and received a smaller total dose of medication during the resuscitation. Although survivors had an overall shorter duration of resuscitation, 5 of 22 patients (23%) survived to discharge despite resuscitation of >30 minutes. Conclusions —The outcome of cardiac arrest in infants after congenital heart surgery was better than that for pediatric intensive care unit populations as a whole. Univentricular physiology did not increase the risk of death after cardiac arrest. Infants with more hemodynamic compromise before the arrest as demonstrated with lower mean arterial blood pressure and higher inotropic support were less likely to survive. The use of predetermined resuscitation end points in this subpopulation may not be justified.

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Abstract 339: Relationship Between Post-arrest Care Hemodynamics and Cerebral Oxygen Saturation in Comatose Survivors of Out-of-hospital Cardiac Arrest: Insights From the CAPITAL-RETURN Trial

Circulation ◽

10.1161/circ.142.suppl_4.339 ◽

2020 ◽

Vol 142 (Suppl_4) ◽

Author(s):

Juan J Russo ◽

Paul Boland ◽

Simon Parlow ◽

Jordan Bernick ◽

Rebecca Mathew ◽

...

Keyword(s):

Intensive Care Unit ◽

Cardiac Arrest ◽

Intensive Care ◽

Intensive Care Unit Admission ◽

Oxygen Delivery ◽

Cerebral Oxygen ◽

Shockable Rhythm ◽

The Mean ◽

The Relationship ◽

Capital Return

Introduction: Comatose survivors of OHCA develop a post cardiac arrest syndrome (PCAS) characterized by myocardial dysfunction and cerebrovascular dysregulation. Hemodynamic derangements related to PCAS can jeopardize cerebral oxygen delivery and therefore impair neurologic recovery. However, optimal hemodynamic targets to ensure adequate cerebral oxygen delivery following OHCA remain undefined. Accordingly, we examined the relationship between cardiac index (CI), mean arterial pressure (MAP), and regional cerebral oxygen saturation (rO 2 %) following OHCA. Methods: CAPITAL-RETURN was a prospective, single-center observational study examining hemodynamics in comatose survivors of OHCA undergoing targeted temperature management after an initial shockable rhythm. Between August 2016 and December 2017, comatose survivors of OHCA underwent continuous, blinded, non-invasive monitoring of CI and rO 2 % using bioimpedance (Cheetah Medical, Portland, OR, USA) and near-infrared spectroscopy (Covidien, Boulder, CO, USA), respectively, for 96 hours after intensive care unit admission. In the present study, we examined the relationship between CI, MAP, and rO 2 % using multivariable linear regression. Results: In 56 patients in this analysis, the mean CI and MAP during the first 96 hours of intensive care unit admission were 3.2±0.5 L/min/m 2 and 76±6 mmHg, respectively (Figure). The mean rO 2 % was 63±9% and increased over time (+0.1% per hour; p<0.001). Higher CI was associated with improved rO 2 % (+3.2% per L/min/m2 increase in CI; p<0.0001). There was no association between MAP and rO 2 % (p=0.42). After adjustment for MAP, the association between CI and rO 2 % remained significant (+3.1% per L/min/m2 increase in CI; p<0.0001). Conclusion: In comatose survivors of OHCA with an initial shockable rhythm, a higher CI is associated with improved rO 2 %. Further studies are needed to determine whether CI targets improve rO2% and neurologic outcomes following OHCA.

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Neuromuscular Blocking Agents and Therapeutic Hypothermia Post Cardiac Arrest in the Intensive Care Unit: Knowledge to Practice

Analgesia & Resuscitation Current Research ◽

10.4172/2324-903x.1000116 ◽

2014 ◽

Vol 03 (02) ◽

Author(s):

Sandra MacDonald

Keyword(s):

Intensive Care Unit ◽

Cardiac Arrest ◽

Intensive Care ◽

Therapeutic Hypothermia ◽

Neuromuscular Blocking ◽

Neuromuscular Blocking Agents ◽

Blocking Agents

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High-Dose Adrenaline in Adult In-Hospital Asystolic Cardiopulmonary Resuscitation: A Double-Blind Randomised Trial

Anaesthesia and Intensive Care ◽

10.1177/0310057x9302100210 ◽

1993 ◽

Vol 21 (2) ◽

pp. 192-196 ◽

Cited By ~ 38

Author(s):

J. Lipman ◽

W. Wilson ◽

S. Kobilski ◽

J. Scribante ◽

C. Lee ◽

...

Keyword(s):

Intensive Care Unit ◽

Cardiac Arrest ◽

Intensive Care ◽

Side Effects ◽

Cardiopulmonary Resuscitation ◽

Standard Dose ◽

Randomised Trial ◽

High Dose ◽

Double Blind ◽

To Receive

Forty intensive care unit patients requiring cardiopulmonary resuscitation were randomised to receive either the standard dose of adrenaline (1 mg every five minutes) or high-dose adrenaline (10 mg every five minutes). In the majority of patients, overwhelming sepsis was the major contributing factor leading to cardiac arrest. In this group of patients no difference could be detected in response to high-dose adrenaline compared with the standard dose. Although no side-effects were noted with this high dose of adrenaline, more investigation is required prior to its routine use in cardiopulmonary resuscitation.

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