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Surviving cardiopulmonary resuscitation

Sudden Cardiac Death and Resuscitation

This session focused on several important issues in modern cardiopulmonary resuscitation (CPR).
First, Professor L.L. Bossaert (Boechout, BE) underlined the importance of looking at arterial oxygen saturation as a double edged sword in cardiopulmonary resuscitation. Although observational data are somewhat conflicting, experimental data clearly show that high levels of oxygen may be toxic.
Therefore, the guidelines recommend that maximum arterial oxygen saturation should be attempted during CPR, but as soon as return of spontaneous circulation (ROSC) is achieved and SaO2 can be measured, then a value of about 94-98% is more appropriate.
The resuscitated cardiac arrest patient often remains comatose after ROSC has been achieved. The circumstances of the CPR are not reliable predictors of outcome.
Therapeutic hypothermia will then often be added for 24 hours. In spite of this therapy, a high percentage of patients admitted alive will still be comatose on day 2-3 and prognostication may be needed.
Dr M. Damian (Cambridge, UK) discussed the best timing of the neuroprognostication in these patients and highlighted that it cannot be done safely before at least 72 hours after normothermia has been regained.
In spite of all the initiatives to improve survival after out-of-hospital cardiac arrest over the last decade, only about 10% survive today.
Professor J. Henriques (Amsterdam,NL) discussed whether rapid mechanical circulatory support could be the way forward in this condition. It will be a resource requiring set-up based on limited data today. Henriques underlined that the most important issue for success in this area will probably be to institutionalize this team-based therapy.
Finally, Dr M. White (London, UK) highlighted the key factors that could influence survival after sudden cardiac arrest. Education and automated external defibrillator (AED) availability are very important, together with securing ongoing circulation at all times with good quality CPR when needed. At the hospital, mild hypothermia therapy and percutaneous coronary intervention (PCI), if indicated, should be performed without delay.





Surviving cardiopulmonary resuscitation

The content of this article reflects the personal opinion of the author/s and is not necessarily the official position of the European Society of Cardiology.