Hospital Response

Post-Cardiac Arrest Care

In the past few years, new evidence has highlighted the important contribution of the medical care provided during the immediate post-cardiac arrest period.1-10

While optimal prehospital care is critical to restore a heartbeat and preserve brain function, the best chance of a favorable outcome is significantly enhanced by systematic delivery of advanced post-cardiac arrest care in the hospital setting.11

The Contribution of Hospital Care

Steps for Survival

Recognition of cardiac arrest and call for help

Early CPR emphasizing chest compressions

Rapid defibrillation

Advanced life support

Advanced post-cardiac arrest hospital care

Due to its importance, post–cardiac arrest care has been elevated to the status of the fifth link in the metaphor used by the American Heart Association (AHA) to describe the interconnectedness of processes involved in the care of the sudden cardiac arrest (SCA) Victim. The AHA’s 2010 Guidelines for Cardiopulmonary Resuscitation (CPR) and Emergency Cardiovascular Care (ECC) now includes a chapter dedicated to the post–cardiac arrest period. 12

Post-Cardiac Arrest Syndrome

Many patients who achieve restoration of spontaneous circulation (ROSC) following out-of-hospital SCA experience Post-Cardiac Arrest Syndrome. This combination of complex pathophysiologic processes develops during the body’s recovery from prolonged whole body ischemia.13 This severe injury progresses because of interactions between injured brain, heart and other organs which can ultimately result in multisystem organ failure and death. Post-cardiac arrest syndrome may be worsened by the precipitating cause of the cardiac arrest.

Objectives of Post-Cardiac Arrest Care

  1. Optimize cardiopulmonary function and vital organ perfusion after ROSC
  2. Transport/transfer to an appropriate hospital or critical care unit with a comprehensive post–cardiac arrest treatment system of care
  3. Identify and treat ACS and other reversible causes
  4. Control temperature to optimize neurologic recovery
  5. Anticipate, treat, and prevent multiple organ dysfunction. This includes avoiding excessive ventilation and hyperoxia
(Highlights of the 2010 American Heart Association Guidelines for CPR and ECC.)

Many of the components of post-cardiac arrest syndrome can be successfully treated. All SCA patients who survive to hospital admission should have the opportunity to benefit from state-of-the-art care to treat possible post-cardiac arrest syndrome. If necessary, patients should be transferred to a critical care unit in an institution that is committed to providing the best possible care addressing which will address all aspects of post-cardiac arrest syndrome.

There are many gaps in both the knowledge and delivery of post-cardiac arrest care. Optimal care for these patients has not been standardized. While regional systems of care have been proposed, they are not yet widely available. One example of a structure that is being explored as a model for a system of care for SCA patients is based on North Carolina’s RACE program, described below. However, regional care protocols for these patient’s do not yet commonly exist. Many physicians who currently care for SCA survivors may be unfamiliar with post-cardiac arrest syndrome and do not have access to evidence-based treatment protocols. 14

Next: Post-Cardiac Arrest Care Guidelines