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Management following resuscitation from cardiac arrest: recommendations from the 2003 Rocky Mountain Critical Care Conference

[Conduite à tenir après la réanimation post-arrêt cardiaque : recommendations de la conférence du Rocky Mountain Critical Care 2003]

Dean D. Bell, MD^*, Peter G. Brindley, MD, David Forrest, MD, Osama Al Muslim, MD and David Zygun, MD

^* From the Departments of Anesthesia and Medicine, University of Manitoba, Winnipeg, Manitoba;
the Division of Critical Care Medicine, University of Alberta, Edmonton, Alberta;
the Department of Medicine, University of British Columbia, Vancouver, British Columbia;
the Division of Critical Care, University of Western Ontario, London, Ontario; and
¶ the Department of Critical Care, University of Calgary, Calgary, Alberta, Canada.

Address correspondence to: Dr. Dean D. Bell, GE706 Health Sciences Centre, 820 Sherbrook Street, Winnipeg, Manitoba R3A 1R9, Canada. Phone: 204-787-3112; Fax: 204-787-3069; E-mail: Dean1{at}mts.net

Purpose: To propose a strategy for the management of patients admitted to critical care units after resuscitation from cardiac arrest.

Source: Prior to the conference relevant studies were identified via literature searches and brief reviews circulated on the following topics: glucose and blood pressure management; therapeutic hypothermia; prearrest outcome prediction; post-arrest outcome prediction; and management of myocardial ischemia. Two days were devoted to assessing evidence and developing a management strategy at the conference. Consensus opinion of conference participants [intensive care unit (ICU) physicians] was used when high grade evidence was unavailable. Additional literature searches and data grading were performed post-conference.

Principal findings: High grade evidence was lacking in most areas. Specific goals of treatment were proposed for: general care; neurologic care; respiratory care; cardiac care; and gastrointestinal care. There was adequate evidence to recommend therapeutic hypothermia for comatose patients who had witnessed ventricular fibrillation or ventricular tachycardia arrests. Conference participants supported extending therapeutic hypothermia to other presenting rhythms in selected circumstances. Additional goals included mean arterial pressure 80 to 100 mmHg, glucose 5 to 8 mmol·L^–1 using insulin infusions, and PaO₂ > 100 mmHg for the first 24 hr. Absent withdrawal to pain 72 hr after resuscitation should prompt consideration of palliative care. The level of evidence for other recommendations was low.

Conclusions: The proposed management strategy represents an approach to manage patients in the ICU following resuscitation from cardiac arrest. Most of the recommendations are based on low grade evidence. Additional research is needed to improve the evidence base. A standard post-arrest management strategy could help facilitate future research.

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