critical care medicine
Cardiac Arrest
Prognosis for Cardiac Arrest
Survival to hospital discharge, particularly neurologically intact survival, is a more meaningful outcome than simply return of spontaneous circulation. Survival rates vary significantly;favorable factorsinclude Early and effective bystander-initiated CPR Witnessed arrest In-hospital location (particularly a monitored unit) Initial rhythm of Ventricular Fibrillation (VF) (VF) or Early defibrillation of VF or VT Postresuscitative care, including circulatory support and access to cardiac catheterization In adults, targeted temperature management (body temperature of 32 to 36° C for ≥ 24 hours) and avoidance of hyperthermia While the American Heart Association 2020 Advanced Cardiac Life Support (ACLS) guidelines recommend cooling to a temperature range between 32° C and 36° C, more recent recommendations from the International Liaison Committee on Resuscitation Advanced Life Support (ALS) suggest actively preventing fever with a target temperature of ≤ 37.5° C rather than active cooling. It is still unclear whether certain groups of patients with cardiac arrest will have improved neurologically intact survival with targeted hypothermia management rather than with maintaining normothermia ( Prognosis references ). If many factors are favorable (eg, VF is witnessed in an intensive care unit or emergency department), 50% of adults with inpatient cardiac arrest may survive to hospital discharge. Overall, survival to hospital discharge in patients experiencing in-hospital arrest varies from 25 to 50%. When factors are uniformly unfavorable (eg, patient in asystole after unwitnessed, out-of-hospital arrest), survival is unlikely. Overall, reported survival after out-of-hospital arrest is about 12%. Only about 10% of all cardiac arrest survivors have good neurologic function, defined as minimal to moderate cerebral disability with ability to perform the majority of activities of daily living independently, at hospital discharge. 1.Bernard SA, Gray TW, Buist MD, et al: Treatment of comatose survivors of out-of-hospital cardiac arrest with induced hypothermia.N Engl J Med346:557–563, 2002. doi 10.1056/NEJMoa003289 2.Granfeldt A, Holmberg MJ, Nolan JP, Soar J, Andersen LW; International Liaison Committee on Resuscitation (ILCOR) Advanced Life Support Task Force: Targeted temperature management in adult cardiac arrest: Systematic review and meta-analysis.Resuscitation167:160–172, 2021. doi:10.1016/j.resuscitation.2021.08.040 3.Merchant RM, Topjian AA, Panchal AR, et al: Part 1: Executive Summary: 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2020;142(16_suppl_2):S337-S357. doi:10.1161/CIR.0000000000000918 4.Nielsen N, Wetterslev J, Cronberg T, et al: Targeted temperature management at 33°C versus 36°C after cardiac arrest.N Engl J Med369:2197–2206, 2013. doi: 10.1056/NEJMoa1310519 5.Wyckoff MH, Greif R, Morley PT, et al: 2022 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations: Summary From the Basic Life Support; Advanced Life Support; Pediatric Life Support; Neonatal Life Support; Education, Implementation, and Teams; and First Aid Task Forces.Circulation146(25):e483–e557, 2022. doi:10.1161/CIR.0000000000001095 