Management of Patients After Out of Hospital Cardiac Arrest
Hypotension is common among cardiac arrest survivors admitted to the ICU. The optimum post-resuscitation blood pressure has not been defined but must be high enough to maintain cerebral perfusion despite impaired cerebral autoregulation but not excessively high because this will increase myocardial work. The target mean arterial blood pressure will be higher than 65 mm Hg but the optimal value will depend on the patient's normal blood pressure and the value that achieves an adequate urine output.
Global myocardial dysfunction, which can be quantified with early and serial echocardiography, is common after cardiac arrest but typically recovers over 48–72 h. Treatment with an inotrope, such as dobutamine, or an intra-aortic balloon pump may be required. Monitoring of cardiac output may be helpful because the inflammatory response associated with post-cardiac arrest syndrome may result in significant vasodilatation, which may require treatment with a vasopressor such as norepinephrine.
Systemic and Cerebral Circulation
Hypotension is common among cardiac arrest survivors admitted to the ICU. The optimum post-resuscitation blood pressure has not been defined but must be high enough to maintain cerebral perfusion despite impaired cerebral autoregulation but not excessively high because this will increase myocardial work. The target mean arterial blood pressure will be higher than 65 mm Hg but the optimal value will depend on the patient's normal blood pressure and the value that achieves an adequate urine output.
Global myocardial dysfunction, which can be quantified with early and serial echocardiography, is common after cardiac arrest but typically recovers over 48–72 h. Treatment with an inotrope, such as dobutamine, or an intra-aortic balloon pump may be required. Monitoring of cardiac output may be helpful because the inflammatory response associated with post-cardiac arrest syndrome may result in significant vasodilatation, which may require treatment with a vasopressor such as norepinephrine.