Post-Resuscitation Hypothermia and Monitoring

Abstract

Unconscious patients resuscitated from cardiac arrest (CA) develop a post-cardiac arrest syndrome. Interventions to manage this syndrome constitute the 5th ring of the chain of survival. ILCOR recommends treating aggressively this syndrome; in this view, the design of standard operating procedures for an aggressive post-resuscitation care may help providing physicians and nurses with management algorithms and targets. Target temperature management—including therapeutic hypothermia (TH, 32–34 °C for 24 h), gradual rewarming, and temperature control afterwards—is the only intervention of the advanced life support (ALS) therapy in the post-resuscitation care period that positively impact on outcome. On the contrary, other ALS interventions, such as drugs and advanced airway management, have not shown improvements in survival. Hypothermia should be induced as soon as feasible, possibly before ICU admission. Careful monitoring of glycemic levels, paO₂, paCO₂ is mandatory as changes in both direction negatively affect patient’s outcome. Previously utilized indicators of poor outcome have been proofed as unreliable after TH. Prognosis should be then delayed by few days, and rely on a multimodal approach including EEG, somatosensory evoked potentials, biomarkers, and neuroimaging.