Prevention and therapy of postresuscitation neurologic dysfunction

The majority of cardiac arrest patients die after successful resuscitation. Despite disappointing survival rates, cardiac arrest research mainly focuses on new therapies applied during cardiac arrest in the out-of-hospital setting, but only little attention is given to therapies mitigating the so-called postresuscitation syndrome. Optimized postresuscitation hospital care might have the potential to substantially improve survival rate in patients after cardiac arrest.

The article will review some aspects of optimized postresuscitation care with the main emphasis on temperature control. Various aspects of ventilation strategies, metabolic control, haemodynamic stabilization, and reperfusion therapies will be summarized.

Therapeutic mild hypothermia (32-34 degrees C) is currently the most advanced medical concept to prevent or mitigate the postresuscitation syndrome. Large prospective randomized clinical trials are needed to investigate normoventilation with blood gases within physiologic range, moderately elevated blood glucose levels, a mean arterial pressure above 80 mmHg, and early reperfusion therapy in all cardiac arrest patients.