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Therapeutic strategies in managing cardiac arrest 

Therapeutic strategies in managing cardiac arrest
Chapter:
Therapeutic strategies in managing cardiac arrest
Author(s):

John Field

DOI:
10.1093/med/9780199600830.003.0064
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date: 27 February 2020

Emergency and critical care specialists are important interdisciplinary physicians who often impact on the long-term survival of patients sustaining cardiac arrest, as well as immediate outcomes. These specialists are often at the crossroads of survival for patients achieving return of spontaneous circulation, and it is important to appreciate that out-of-hospital and in-hospital cardiac arrest patients represent different pathophysiological subgroups with respect to aetiology and pathophysiology. Important time-dependent triage and therapy are crucial, and efforts to identify and treat pathophysiological triggers share priority with the initiation of hypothermia protocols and other targeted interventions, such as coronary angiography and percutaneous coronary intervention. Updated basic life support (BLS) and advanced life support (ACLS) protocols emphasize the importance of high quality chest compressions as central to achieving return of spontaneous circulation and emphasize that airway interventions should not detract from this objective. No specific ACLS intervention including intubation, vasopressor therapy or use of anti-arrhythmic agents has been found to improve outcome. The goal of both BLS and ACLS protocols is the achievement of return of spontaneous circulation, the prevention of re-arrest and the initiation of immediate post-resuscitation interventions associated with improved outcome. These include targeted temperature management (induced hypothermia) and coronary angiography for appropriate patients and ‘bundled’ critical care for all recognizing that the post-arrest state is a systemic inflammatory condition requiring multidisciplinary care beyond hypothermia and cardiovascular support.

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