Critical Care Management after Cardiac Arrest

Sudden cardiac arrest is a devastating event with high mortality and substantial morbidity among survivors. Early recognition and intervention to restore circulation is the primary goal; once that is achieved, the path toward a meaningful recovery starts. Initial in-hospital care is focused on emergency cardiac care, but soon there is a change to a more brain-oriented critical care including targeted temperature management, brain monitoring, sedation, and repeated neurologic assessments. In patients who show early signs of awakening from coma once sedation has been stopped, the prognosis is generally good. In patients with early seizures and prolonged coma after sedation has been weaned, the prognosis is often poor. A structured model for neuroprognostication using several prognostication tools such as imaging, neurophysiology, biomarkers, and above all repeated clinical investigations is fundamental for the ability to properly assess the comatose cardiac arrest patient and to enable accurate and trustworthy decisions on level of care. The authors present a model for critical care management after cardiac arrest and a neuroprognostication algorithm, both in use at their institution.