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Neurocrit Care. 2017 Sep;27(Suppl 1):134-143. doi: 10.1007/s12028-017-0457-9.

Emergency Neurological Life Support: Resuscitation Following Cardiac Arrest.

Author information

1
Department of Emergency Medicine, University of Pittsburgh School of Medicine, Iroquois Building, Suite 400A, 3600 Forbes Avenue, Pittsburgh, PA, 15213, USA. elmerjp@upmc.edu.
2
Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA. elmerjp@upmc.edu.
3
Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.

Abstract

Cardiac arrest is the most common cause of death in North America. An organized bundle of neurocritical care interventions can improve chances of survival and neurological recovery in patients who are successfully resuscitated from cardiac arrest. Therefore, resuscitation following cardiac arrest was chosen as an Emergency Neurological Life Support protocol. Key aspects of successful early post-arrest management include: prevention of secondary brain injury; identification of treatable causes of arrest in need of emergent intervention; and, delayed neurological prognostication. Secondary brain injury can be attenuated through targeted temperature management (TTM), avoidance of hypoxia and hypotension, avoidance of hyperoxia, hyperventilation or hypoventilation, and treatment of seizures. Most patients remaining comatose after resuscitation from cardiac arrest should undergo TTM. Treatable precipitants of arrest that require emergent intervention include, but are not limited to, acute coronary syndrome, intracranial hemorrhage, pulmonary embolism and major trauma. Accurate neurological prognostication is generally not appropriate for several days after cardiac arrest, so early aggressive care should never be limited based on perceived poor neurological prognosis.

KEYWORDS:

Anoxic brain injury; Cardiac arrest; Emergency Neurological Life Support; Neurocritical care; Prognosis; Resuscitation

PMID:
28913711
DOI:
10.1007/s12028-017-0457-9
[Indexed for MEDLINE]

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