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29 - Intensive care of cardiac arrest survivors

from Section 4 - Neurointensive care

Published online by Cambridge University Press:  05 December 2011

Basil F. Matta
Affiliation:
Addenbrooke's Hospital, Cambridge
David K. Menon
Affiliation:
Addenbrooke's Hospital, Cambridge
Martin Smith
Affiliation:
Department of Neuroanaesthesia and Neurocritical Care, the National Hospital for Neurology and Neurosurgery, University College London Hospitals
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Summary

This chapter provides a pragmatic approach to intensive care unit (ICU) admission, acute treatment and prognostication of cardiac arrest survivors. The criteria for ICU admission should be based on the prioritization of patients likely to benefit from ICU care. The pathophysiological processes involved in post-cardiac arrest syndrome are treatable and include: a systemic ischaemia/reperfusion response; post-cardiac arrest myocardial dysfunction; and post-cardiac arrest brain injury. The clinical manifestations of post-cardiac arrest brain injury include disorders of arousal and awareness, seizures, neuropsychological dysfunction and brain death. The priorities of the acute intensive care management of cardiac arrest survivors are: provision of organ support; prevention of recurrence; minimization of ongoing cerebral and cardiac injury; and prompt diagnosis and treatment of the disease that lead to cardiac arrest and underlying comorbidities. Emerging consensus is that after therapeutic hypothermia, prognostication should be delayed until at least 3 days at er normothermia has been restored.
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Publisher: Cambridge University Press
Print publication year: 2011

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