Post-Cardiac Arrest Syndrome, A Consensus Statement
Post-cardiac arrest syndrome (PCAS) is characterized by brain injury, myocardial dysfunction, and systemic inflammation, often complicated by the unresolved pathophysiological process that caused the cardiac arrest.
Together these processes are associated with high mortality rates. A study of cardiac arrest resuscitation conducted in 2006 found that in hospital mortality was 67% among adults and 55% among children, despite all surviving the initial cardiac arrest.
This consensus statement describes the original ABCDs of resuscitation in which A represents airway, B represents breathing, C is circulation and D is definitive therapy. Definitive therapy includes not only the management of pathologies that cause cardiac arrest but also those that result from cardiac arrest. Barriers to implementation of the recommended strategies are also addressed.
Potential treatments are specific to the syndrome being addressed, i.e. Post-cardiac phases of brain injury, myocardial dysfunction, systemic ischemia and persistent precipitating pathology. Potential treatments for these syndromes include therapeutic hypothermia, early hemodynamic optimization, airway protection and mechanical ventilation, seizure control, controlled reoxygenation, supportive care, early revascularization of acute myocardial infarction, early hemodynamic optimization, intravenous fluid, inotropes, intra-aortic balloon pump, left ventricular assist device, extracorporeal membrane oxygenation, vasopressors, high volume hemofiltration, temperature control, glucose control, antibiotics,and disease-specific interventions guided by patient condition concomitantly with post-cardiac arrest syndrome. A chart lining up the therapies recommended for each coordinating syndrome is included in the original document available for viewing online in the October issue of Circulation.
Care of the PCA patient is time-sensitive, occurs both in and out of the hospital and is provided by a diverse team of healthcare providers. The consensus statement urges a multidisciplinary approach to this problem in all phases of treatment and follow-up care.
The statement focuses on the components of care that specifically impact the PCA patient. The time-sensitive nature of therapeutic strategies is emphasized as well as the impact of therapeutic strategies on individual components of the system. A table on monitoring options is included in the statement to guide the healthcare provider on minimum standards for PCA patient care monitoring and follow-up. A special section focuses on pediatric management of PCA.
And, last, but not least, implementation strategies for the guidelines are outlined along with the barriers to such implementation. All in all, this consensus statement covers an entire program of an intervention delivery system to adult and pediatric PCA patients.
About the author
Kathy Shattler received her Master of Science degree from Michigan State University in E. Lansing Michigan in Human Nutrition. Her twenty-two years of practice includes holding positions as a Lecturer, Chief Clinical Dietitian and Program Manager. Kathy is the Founder of Nutri-Care Consulting and is currently the Nutrition Director of www.CEU4U.COM, an online continuing education management company for Registered Dietitians and Dietetic Technicians.
