Pothiawala Sohil
Department of Emergency Medicine, Singapore General Hospital, Singapore.
Singapore Med J. 2017 Jul;58(7):404-407. doi: 10.11622/smedj.2017060.
Following return of spontaneous circulation (ROSC) after cardiac arrest, the challenge is to institute measures that ensure a higher likelihood of neurologically intact survival. Regardless of the cause of collapse, multiple organ systems may be affected secondary to post-cardiac arrest syndrome. Interventions required for post-ROSC care are bundled into a care regimen: prompt identification and treatment of the cause of cardiac arrest; and treatment of electrolyte abnormalities. It is also essential to establish definitive airway management to maintain normocapnic ventilation, prevent hyperoxia, and optimise haemodynamic management via judicious intravenous fluids and vasoactive drugs. Targeted temperature management after ROSC confers neuroprotection and leads to improved neurological outcomes. Glycaemic control of blood glucose levels at 6-10 mmol/L, adequate seizure management and measures to optimise neurological functions should be integrated into the care bundle. The interventions outlined can potentially lead to more patients being discharged from hospital alive with good neurological function.
心脏骤停后自主循环恢复(ROSC)后,面临的挑战是采取措施,以确保患者在神经功能完好的情况下存活的可能性更高。无论心脏骤停的原因是什么,心脏骤停后综合征可能会继发影响多个器官系统。ROSC后护理所需的干预措施被整合到一个护理方案中:迅速识别和治疗心脏骤停的原因;以及治疗电解质异常。建立确定性气道管理以维持正常碳酸血症通气、预防高氧血症,并通过合理使用静脉输液和血管活性药物优化血流动力学管理也至关重要。ROSC后进行目标温度管理可提供神经保护并改善神经功能结局。将血糖水平控制在6-10 mmol/L、充分控制癫痫发作以及优化神经功能的措施应纳入护理方案中。上述干预措施有可能使更多患者存活出院且神经功能良好。