Management of Comatose Survivors of Cardiac Arrest

David B. Seder, MD, FCCP, FCCM, FNCS p. 1732-1752 December 2018, Vol.24, No.6 doi: 10.1212/CON.0000000000000669
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PURPOSE OF REVIEW: Because the whole-body ischemia-reperfusion insult associated with cardiac arrest often results in brain injury, neurologists perform an important role in postresuscitation cardiac arrest care. This article provides guidance for the assessment and management of brain injury following cardiac arrest.

RECENT FINDINGS: Neurologists have many roles in postresuscitation cardiac arrest care: (1) early assessment of brain injury severity to help inform triage for invasive circulatory support or revascularization; (2) advocacy for the maintenance of a neuroprotective thermal, hemodynamic, biochemical, and metabolic milieu; (3) detection and management of seizures; (4) development of an accurate, multimodal, and conservative approach to prognostication; (5) application of shared decision-making paradigms around the likely outcomes of therapy and the goals of care; and (6) facilitation of the neurocognitive assessment of survivors. Therefore, optimal management requires early neurologist involvement in patient care, a detailed knowledge of postresuscitation syndrome and its complex interactions with prognosis, expertise in bringing difficult cases to their optimal conclusions, and a support system for survivors with cognitive deficits.

SUMMARY: Neurologists have a critical role in postresuscitation cardiac arrest care and are key participants in the treatment team from the time of first restoration of a perfusing heart rhythm through the establishment of rehabilitation services for survivors.

Address correspondence to Dr David B. Seder, Maine Medical Center, 22 Bramhall St, Portland, ME 04103, sederd@mmc.org.

RELATIONSHIP DISCLOSURE: Dr Seder receives grant support from the Patient-Centered Outcomes Research Institute (CER-1602-34137).

UNLABELED USE OF PRODUCTS/INVESTIGATIONAL USE DISCLOSURE: Dr Seder discusses the unlabeled/investigational use of the bispectral index in determining the severity of brain injury after cardiac arrest.

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© 2018 American Academy of Neurology