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Canadian Journal of Cardiology

Cardiac Intensive Care Unit Management of Patients After Cardiac Arrest: Now the Real Work Begins

Published:November 29, 2017DOI:https://doi.org/10.1016/j.cjca.2017.11.013

      Abstract

      Survival with a good quality of life after cardiac arrest continues to be abysmal. Coordinated resuscitative care does not end with the effective return of spontaneous circulation (ROSC)—in fact, quite the contrary is true. Along with identifying and appropriately treating the precipitating cause, various components of the post–cardiac arrest syndrome also require diligent observation and management, including post–cardiac arrest neurologic injury and myocardial dysfunction, systemic ischemia-reperfusion phenomenon with potential consequent multiorgan failure, and the various sequelae of critical illness. There is growing evidence that an early invasive approach to coronary reperfusion with percutaneous coronary intervention, together with active targeted temperature management and optimization of hemodynamic, ventilator, and metabolic parameters, may improve survival and neurologic outcomes in cardiac arrest survivors. Neuroprognostication is complex, as are survivorship issues and long-term rehabilitation. Our paramedics, emergency physicians, and resuscitation specialists are all to be congratulated for ever-increasing success with ROSC… but now the real work begins.

      Résumé

      Les chances de survie avec une bonne qualité de vie après un arrêt cardiaque continuent d’être très minces. Les soins coordonnés de réanimation ne s’arrêtent pas avec la reprise de l’activité circulatoire spontanée (RACS) – en fait, c’est plutôt le contraire. En plus des facteurs déclenchants qu’il faut déterminer et traiter adéquatement, divers autres aspects du syndrome post-arrêt cardiaque commandent également une évaluation et une prise en charge attentives, notamment les lésions neurologiques et la dysfonction myocardique consécutives à l’arrêt cardiaque, le phénomène d’ischémie-reperfusion globale pouvant entraîner une défaillance organique multiple et les diverses séquelles pouvant être associées à une maladie grave. De plus en plus de données montrent que l’adoption d’une approche effractive précoce de reperfusion coronarienne, par intervention coronarienne percutanée, associée à un contrôle ciblé de la température et à un ajustement optimal des paramètres hémodynamiques, ventilatoires et métaboliques peut améliorer la survie et les résultats neurologiques chez les patients ayant survécu à un arrêt cardiaque. L’établissement du neuropronostic est complexe, tout comme le sont les difficultés auxquelles les survivants doivent faire face et la réadaptation à long terme. Ambulanciers, urgentologues et spécialistes de la réanimation méritent tous nos félicitations pour leur capacité sans cesse croissante d’obtenir une RACS… mais c’est à ce moment que le véritable travail commence.
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