Kang Youngjoon
Department of Emergency Medicine, Jeju National University Hospital, Jeju, Korea.
Acute Crit Care. 2019 Aug;34(3):173-178. doi: 10.4266/acc.2019.00654. Epub 2019 Aug 31.
Post-cardiac arrest syndrome is a complex and critical issue in resuscitated patients undergone cardiac arrest. Ischemic-reperfusion injury occurs in multiple organs due to the return of spontaneous circulation. Bundle of management practicies are required for post-cardiac arrest care. Early invasive coronary angiography should be considered to identify and treat coronary artery obstructive disease. Vasopressors such as norepinephrine and dobutamine are the first-line treatment for shock. Maintainance of oxyhemoglobin saturation greater than 94% but less than 100% is recommended to avoid fatality. Target temperature therapeutic hypothermia helps to resuscitated patients. Strict temperature control is required and is maintained with the help of cooling devices and monitoring the core temperature. Montorings include electrocardiogram, oxymetry, capnography, and electroencephalography (EEG) along with blood pressue, temprature, and vital signs. Seizure should be treated if EEG shows evidence of seizure or epileptiform activity. Clinical neurologic examination and magnetic resonance imaging are considered to predict neurological outcome. Glycemic control and metabolic management are favorable for a good neurological outcome. Recovery from acute kidney injury is essential for survival and a good neurological outcome.
心脏骤停后综合征是心脏骤停复苏患者中一个复杂而关键的问题。由于自主循环恢复,多个器官会发生缺血再灌注损伤。心脏骤停后护理需要一系列管理措施。应考虑早期进行有创冠状动脉造影以识别和治疗冠状动脉阻塞性疾病。去甲肾上腺素和多巴酚丁胺等血管升压药是休克的一线治疗药物。建议将氧合血红蛋白饱和度维持在94%以上但低于100%,以避免死亡。目标温度治疗性低温有助于复苏患者。需要严格控制温度,并借助冷却设备和监测核心温度来维持。监测包括心电图、血氧测定、二氧化碳描记图和脑电图(EEG),以及血压、体温和生命体征。如果脑电图显示有癫痫发作或癫痫样活动的证据,应治疗癫痫发作。临床神经学检查和磁共振成像被认为可预测神经学转归。血糖控制和代谢管理有利于良好的神经学转归。急性肾损伤的恢复对于生存和良好的神经学转归至关重要。