The post-resuscitation bundle

Following restoration of pulse after the institution of cardiopulmonary resuscitation, defibrillation and perhaps, the initial resuscitative drugs, there is a greater challenge of maintaining that heartbeat for at least the next 24 hours, which can better ensure a high likelihood of the patient being discharged alive from the hospital. A bundle of procedures, which may need to be administered simultaneously, is required. These include prompt identification and treatment of the cause of cardiac arrest, with early consideration for procedures such as percutaneous coronary interventions and fibrinolytics, and treatment of electrolyte abnormalities. In addition, a definitive airway and normocapnoeic ventilation without causing hyperoxaemia, together with rational management of haemodynamics with intra-arterial and central venous lines and vasoactive agents will be crucial. Additional benefit is possible with appropriate forms of early goal-directed therapy and achieving therapeutic hypothermia within the first few hours, followed by gradual rewarming and ensuring glycaemic control by maintaining blood sugars within a range of 6-10 mmol /L. All these would be important and need to be continued for at least 24 hours, together with a series of measures to control neurological reactions and monitor neurological responses for best effect. Creation of a bundle that incorporates these various aspects of care would more likely ensure that most patients who achieve return of spontaneous circulation may be discharged alive from the hospital with optimal neurological function.