Postresuscitation Management And Outcomes

Most patients who achieve return of spontaneous circulation (ROSC) do not survive to hospital discharge. Focus on postarrest care is critical to maximize outcomes. In the post-ROSC phase, patients are frequently hemodynamically unstable, electrophysiologically vulnerable, and in need of airway management and/or ventilatory support. While focusing on further stabilizing the patient, attention should also be placed on identifying the etiology of arrest and minimizing postischemic injury to the brain and other organs. Goal-directed therapy can provide optimal care and outcomes. Neurologic prognostication should wait until 72 hours after ROSC or return to normothermia. If a patient remains is recognized as brain dead, tissue and organ donation should be considered. Debriefing after cardiopulmonary resuscitation improves objective measures in future resuscitation and allows a chance for closure after a stressful event. This review contains 4 figures, 4 tables and 42 references Key words: cardiac arrest, postarrest care, post–cardiac arrest syndrome, postresuscitation management, target temperature management, therapeutic hypothermia

THE APPLICATION OF THE NEW 2015 AHA GUIDELINES ON UPDATE FOR CARDIOPULMONARY RESUSCITATION AND EMERGENCY CARDIOVASCULAR CARE: ON OCCASION OF A SUCCESSFUL CASE AT HANOI MEDICAL UNIVERSITY HOSPITAL

Cardiac arrest is associated with high mortality if without early diagnosis and cardiopulmonary resuscitation. Each minute without emergency cardiopulmonary resuscitation (CPR), the patient’s chance of survival is reduced by ten percent, even if properly resuscitated but not recirculated, the chance of survival is reduced by four percent. Therefore, CPR should be ferformed as soon as patient is diagnosed with cardiac arrest with the signs of unconsciousness, apnea, loss of carotid pulse and inguinal pulse. Chest compression plays an important role in the success of CPR. There is emphasis on the characteristics of high-quality CPR: compressing the chest at an adequate rate and depth, allowing complete chest recoil after each compression, minimizing interruptions in compressions, and avoiding excessive ventilation. Emergency coronary angiography is recommended for all patients with ST elevation and for hemodynamically or electrically unstable patients without ST elevation for whom a cardiovascular lesion is suspected. All adult patients with return of spontaneous circulation after cardiac arrest should have targeted temperature management (TTM) to prevent poor neurologic outcome. Key words: Cardiac arrest, targeted temperature management, the 2015 AHA Guideline on CPR and ECC

Case Report on Cardiac Arrest Under Spinal Anesthesia in a Case of Caesarean Section

A 33 years old multiparous woman was admitted in Dhaka National Medical Institute Hospital with the complaints of 37 weeks pregnancy and less fetal movement. She was a known case of DM & had a previous history of caesarean section. She had under gone an emergency caesarean section under spinal anesthesia. Patient developed sudden severe hypotension with respiratory distress within 3-4 minutes after the anesthetic procedure, while she was in supine position. Subsequently she developed cardiac arrest. She was managed by cardiopulmonary resuscitation which included prompt tracheal intubation, ventilation with 100% oxygen, cardiac message & ionotropic drug. Cardiac arrest was revived. The operation was completed under general anaesthesia & was reversed uneventful. She was kept in CCU under close monitoring. The patient was discharged on her 7th postoperative day with a healthy baby and a healthy physical status. Key words: Cardiac arrest, Spinal anaesthesia, Supine hypotensive syndrome. Journal of BSA, Vol. 19, No. 1 & 2, 2006 p.54-56