Critical care of patients after cardiac arrest is crucial, needs more research

(Press-News.org) Statement Highlights:

Intensive care management of cardiac arrest survivors is important and influences survival and neurological outcomes. This collaborative statement from a diverse group with expertise in post-cardiac arrest care identifies current knowledge gaps and provides guidance about care in topics where research and existing guidelines were not able to provide solid evidence. This statement calls for more research into neurological, cardiac, pulmonary, hematologic, infectious, gastrointestinal, endocrine and general critical care management after cardiac arrest. Embargoed until 4 a.m. CT / 5 a.m. ET Tuesday, Nov. 28, 2023

DALLAS, Nov. 28, 2023 — A new consensus statement from the American Heart Association Emergency and Cardiovascular Care Committee and the Neurocritical Care Society calls for more research to address areas of post-cardiac arrest care that have limited research. The statement published today simultaneously in the Association’s flagship journal Circulation and in Neurocritical Care, the Neurocritical Care Society’s journal.

Cardiac arrest affects over 600,000 people in the United States annually, with a worldwide annual incidence of 30 to 97 individuals per 100,000 population.[1]

While guidelines address some relevant topics based on large bodies of scientific evidence, like temperature control and neurological prognostication, many important subject areas have less evidence to support practice or to be included in guidelines. A scientific statement is an expert analysis of current research and may inform future clinical practice guidelines.

In this scientific statement, the consensus panel outlines suggestions to address the following topics in post-cardiac arrest care: neurological, cardiac, pulmonary, hematologic, infectious, gastrointestinal, endocrine and general critical care management.

“This is not just a heart, brain or lung problem, this is a whole-body problem,” said Romergryko G. Geocadin, M.D., professor of neurology at Johns Hopkins Hospital and chair of the writing committee. “After they resuscitate, many professionals think they’ve done their job, however, there’s much more to do after that moment, and it should be a more cohesive team providing care from there on.”      

The expert panel categorized the needs for future research by body system, and concluded:

Neurological management in the Intensive Care Unit (ICU) includes future research considerations for the use of advanced seizure monitoring techniques, and the influence of analgesic, sedative and neuromuscular blockade agents. Cardiac management in the ICU includes hemodynamics, monitoring and mechanical circulatory support, and considerations for timing and appropriateness of cardiac catheterization. Pulmonary and hematologic management in the ICU needs future research on the impact of oxygenation and ventilation on all organs, and studies on the safety and efficacy of early thromboprophylaxis in patients after cardiac arrest are warranted. Additional system and disease management in the ICU includes digestive system management, infectious disease management and endocrine and fluids management. Management of these systems and diseases is an important aspect of critical care management, and future research is needed. “Until high-quality studies that inform practice guidelines in these areas are available, we hope this statement will help further advise clinicians on the critical care management of patients after cardiac arrest,” said Karen G. Hirsch, M.D., associate professor of neurology and neurosurgery at Stanford University and co-chair of the writing committee.

This scientific statement was prepared by the volunteer writing group on behalf of the American Heart Association and the Neurocritical Care Society. American Heart Association scientific statements promote greater awareness about cardiovascular diseases and stroke issues and help facilitate informed health care decisions. Scientific Statements outline what is currently known about a topic, and what areas need additional research. While scientific statements inform the development of guidelines, they do not make treatment recommendations. American Heart Association guidelines provide the Association’s official clinical practice recommendations.

Additional writing group members include: Benjamin S. Abella, M.D., M.Phil., FAHA; Edilberto Amorim, M.D.; Mary Kay Bader, R.N., M.S.N., FAHA; Jeffrey F. Barletta, Pharm.D.; Katherine Berg, M.D.; Clifton W. Callaway, M.D., Ph.D., FAHA; Hans Friberg, M.D., Ph.D.; Emily J. Gilmore, M.D.; David M. Greer, M.D., FAHA; Karl B. Kern, M.D., FAHA; Sarah Livesay, D.N.P., R.N.; Teresa L. May, D.O.; Robert W. Neumar, M.D., Ph.D., FAHA; Jerry P. Nolan, M.D.; Mauro Oddo, M.D.; Mary Ann Peberdy, M.D., FAHA; Samuel M. Poloyac, Pharm.D., Ph.D.; David Seder, M.D., FAHA; Fabio Silvio Taccone, M.D., Ph.D.; Anezi Uzendu, M.D.; Brian Walsh, Ph.D., R.R.T.; and Janice L. Zimmerman, M.D. Disclosures are listed in the manuscript.

The Association receives funding primarily from individuals. Foundations and corporations (including pharmaceutical, device manufacturers and other companies) also make donations and fund specific Association programs and events. The Association has strict policies to prevent these relationships from influencing the science content. Revenues from pharmaceutical and biotech companies, device manufacturers and health insurance providers and the Association’s overall financial information are available here.

Additional Resources:

Multimedia is available in the right column of the release https://newsroom.heart.org/news/critical-care-of-patients-after-cardiac-arrest-is-crucial-needs-more-research?preview=a8d408134c7c44f8f494475f05e4bcf5 Link to full study AHA health information: Resuscitation Science AHA cardiac arrest initiative: Join the Nation of Lifesavers AHA Hands-Only CPR training: Hands-Only CPR video   ###

About the American Heart Association

The American Heart Association is a relentless force for a world of longer, healthier lives. We are dedicated to ensuring equitable health in all communities. Through collaboration with numerous organizations, and powered by millions of volunteers, we fund innovative research, advocate for the public’s health and share lifesaving resources. The Dallas-based organization has been a leading source of health information for nearly a century. Connect with us on heart.org, Facebook, X or by calling 1-800-AHA-USA1.

About the Neurocritical Care Society

The Neurocritical Care Society (NCS) is proud to be the only professional society representing multi-disciplinary teams of neurocritical care providers around the world whose mission is to improve outcomes for patients with life-threatening neurological illnesses. The NCS community includes more than 3,000 neurocritical care providers from 50 different countries. For more information about the NCS, visit www.neurocriticalcare.org.

For Media Inquiries:

American Heart Association: Sarah D. Williams, sarah.d.williams@heart.org

Neurocritical Care Society: Kat Seiffert, kseiffert@neurocriticalcare.org

For Public Inquiries: 1-800-AHA-USA1 (242-8721)

heart.org and stroke.org

[1] Virani SS, Alonso A, Benjamin EJ, Bittencourt MS, Callaway CW, Carson AP, Chamberlain AM, Chang AR, Cheng S, Delling FN, et al; on behalf of the American Heart Association Council on Epidemiology and Prevention Statistics Committee and Stroke Statistics Subcommittee. Heart disease and stroke statistics—2020 update: a report from the American Heart Association. Circulation. 2020;141:e139–e596. doi: 10.1161/CIR.0000000000000757

Kiguchi T, Okubo M, Nishiyama C, Maconochie I, Ong MEH, Kern KB, Wyckoff MH, McNally B, Christensen EF, Tjelmeland I, et al. Out-of-hospital cardiac arrest across the world: first report from the International Liaison Committee on Resuscitation (ILCOR). Resuscitation. 2020;152:39–49. doi: 10.1016/j.resuscitation.2020.02.044

Tsao CW, Aday AW, Almarzooq ZI, Alonso A, Beaton AZ, Bittencourt MS, Boehme AK, Buxton AE, Carson AP, Commodore-Mensah Y, et al; on behalf of the American Heart Association Council on Epidemiology and Prevention Statistics Committee and Stroke Statistics Subcommittee. Heart disease and stroke statistics—2022 update: a report from the American Heart Association [published correction appears in Circulation. 2022;146:e141]. Circulation. 2022;145:e153–e639. doi: 10.1161/CIR.0000000000001052

 

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