Postresuscitative intensive care: neuroprotective strategies after cardiac arrest

Semin Neurol. 2006 Sep;26(4):396-402. doi: 10.1055/s-2006-948320.

Abstract

Cardiac arrest is a common disease in the United States, and many patients will die as a result of the neurological damage suffered during the anoxic period, or will live in a neurologically debilitated state. When cardiopulmonary-cerebral resuscitation results in the return of spontaneous circulation, intensive care is required to optimize neurological recovery. Such "brain-oriented" therapies include routine care, such as positioning and maintenance of volume status; optimization of cerebral perfusion, with the use of vasopressors if needed; management of increased intracranial pressure with agents such as hypertonic saline; assuring adequate oxygenation and avoiding hypercapnia; aggressive fever control; intensive glucose control, with the use of an insulin drip if needed; and management of seizures if they occur. To date, no neuroprotectant medications have been shown to improve neurological outcome. Induced moderate therapeutic hypothermia is utilized as a neuroprotective maneuver. Future treatment options and advanced monitoring techniques are also discussed. Further study to optimize neuroprotective strategies when treating patients who survive cardiac arrest is needed.

Publication types

  • Research Support, N.I.H., Extramural
  • Review

MeSH terms

  • Brain Infarction / etiology
  • Brain Infarction / prevention & control*
  • Brain Infarction / therapy*
  • Cardiopulmonary Resuscitation / standards
  • Cardiopulmonary Resuscitation / trends
  • Cerebrovascular Circulation / drug effects
  • Cerebrovascular Circulation / physiology
  • Heart Arrest / complications*
  • Heart Arrest / therapy
  • Humans
  • Hypercapnia / physiopathology
  • Hypercapnia / prevention & control
  • Hypercapnia / therapy
  • Hypoxia-Ischemia, Brain / etiology
  • Hypoxia-Ischemia, Brain / prevention & control*
  • Hypoxia-Ischemia, Brain / therapy*
  • Intensive Care Units / standards*
  • Intensive Care Units / trends
  • Intracranial Hypertension / physiopathology
  • Intracranial Hypertension / prevention & control
  • Intracranial Hypertension / therapy
  • Reperfusion Injury / etiology
  • Reperfusion Injury / prevention & control
  • Reperfusion Injury / therapy
  • Vasoconstrictor Agents / therapeutic use

Substances

  • Vasoconstrictor Agents