Considerations in the long-term management of survivors of cardiac arrest

The heterogeneity of resuscitated patients at risk of recurrent cardiac arrest serves to make their management difficult and complex. It is logical that therapy should be tailored to each patient and certainly to the mechanism whereby sudden cardiac death occurred. It is important, also, to recognize that not all resuscitated victims are at high risk for recurrence and that aggressive interventions are not necessarily mandatory. In the patient with cardiac arrest related to transient myocardial ischemia, a direct approach toward relieving ischemia seems appropriate. Antiarrhythmic agents may have a role in the treatment of some patients, but to this date the efficacy of such therapy is speculative, at best. The development and testing of agents that have "antifibrillatory" properties seems a logical approach at this time. Clearly, efforts to lessen the mortality of patients who have been resuscitated from out-of-hospital cardiac arrest are important, not only for the particular patients themselves, but also in an effort to develop rational, prophylactic interventions for the large numbers of patients with coronary heart disease who are at risk for the development of sudden cardiac death.