Key Hospitalist Clinical Practice Guidelines in 2017

Neuroprotection After Cardiac Arrest

American Academy of Neurology

For patients who are comatose in whom the initial cardiac rhythm is either pulseless ventricular tachycardia (VT) or ventricular fibrillation (VF) after out-of-hospital cardiac arrest (OHCA), therapeutic hypothermia (TH; 32-34°C for 24 hr) is highly likely to be effective in improving functional neurologic outcome and survival compared with non-TH and should be offered.

For patients who are comatose in whom the initial cardiac rhythm is either VT/VF or asystole/pulseless electrical activity (PEA) after OHCA, targeted temperature management (36°C for 24 hr, followed by 8 hr of rewarming to 37°C, and temperature maintenance below 37.5°C until 72 hr) is likely as effective as TH and is an acceptable alternative.

For patients who are comatose with an initial rhythm of PEA/asystole, TH possibly improves survival and functional neurologic outcome at discharge vs standard care and may be offered.

Prehospital cooling as an adjunct to TH is highly likely to be ineffective in further improving neurologic outcome and survival and should not be offered. Other pharmacologic and nonpharmacologic strategies (applied with or without concomitant TH) are also reviewed.

References

• Anderson P. New AAN Guidelines on Neuroprotection After Cardiac Arrest. Medscape. WebMD Inc. May 17, 2017. http://www.medscape.com/viewarticle/880135

• Geocadin RG, Wijdicks E, Armstrong MJ, et al. Practice guidelines summary: Reducing brain injury following cardiopulmonary resuscitation. Neurology. May 30, 2017. Vol. 88, no.22, pp 2141-49. http://www.neurology.org/content/88/22/2141

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Any views expressed above are the author's own and do not necessarily reflect the views of WebMD or Medscape.

Cite this: John Anello, Brian Feinberg, John Heinegg, et. al. Key Hospitalist Clinical Practice Guidelines in 2017 - Medscape - Jan 16, 2018.