Cardiovascular Critical Care II
| (c) | For patients with ictal-interictal continuum patterns on electroencephalography can be |
|---|
given nonsedating antiseizure medications (i.e., non-benzodiazepine).
iv.
Renal dysfunction: The indications for initiating renal replacement therapy in cardiac arrest
Infectious disease: Association has been shown between the use of prophylactic antibiotics
and decreased incidence of pneumonia and sepsis (Resuscitation 2015;92:154-9) in patients
who underwent temperature control to goal 32-34°C. Impact on length of stay or neurological
outcome was not demonstrated and no information is available regarding impact of higher
temperature goals on the above outcomes.
Assess prognosis.
Brain injury and cardiovascular instability are the main determinants of survival after cardiac
ii.
If temperature control is used, a delay of 72 hours after rewarming should be implemented for
prognostication.
iii.
If temperature control is not considered:
| (a) | Prognostication should wait until 72 hours after ROSC. |
|---|---|
| (b) | No clinical neurologic sign has shown to be predictive of neurologic prognosis less than 24 |
iv.
Prudent to perform any prognostication after removal of opioids, sedatives, paralytics, and so
forth.
Using several modalities of testing including clinical examination, neurophysiological testing,
and imaging is recommended.
Recovery – Care and support during recovery (Circulation 2020;142(16_suppl_2):S366-468)
Assist survivors with rehabilitation needs. Multimodal rehabilitation assessment and treatment
of physical, neurologic, cardiopulmonary, and cognitive impairments are recommended before
hospital discharge.
ii.
Cardiac arrest survivors and their caregivers are recommended to receive comprehensive,
multidisciplinary discharge planning, including medical and rehabilitative treatment
recommendations, and to return to activity/work expectations.
iii.
Structured assessment for anxiety, depression, posttraumatic stress, and fatigue is recommended
for cardiac arrest survivors and their caregivers.
iv.
New recommendations also call for provider debriefing and referral for emotional support,
when needed, for those responding to and participating in resuscitation efforts.