Focus on post-resuscitation care

Mortality in patients resuscitated from cardiac arrest (CA) is high, the main causes being hypoxic-ischaemic brain injury (HIBI) and circulatory failure. Current research on post-resuscitation care focuses on interventions aimed at reducing their occurrence. Recent trials have questioned the benefit of recommended interventions in post-resuscitation care. They include immediate coronary angiography in survivors of out-of hospital CA without ST-segment elevation on their ECG, high-normal PaCO2 and moderate hyperoxia in the post-resuscitation period. On the other hand, pilot studies showed that cerebral perfusion pressure evaluated using trans-cranial Doppler may be a target of early haemodynamic management after resuscitation. Newly identified biomarkers – such as the neurofilament light chain (NFL) can accurately assess the degree of HIBI in comatose CA survivors and predict neurological outcome. The advantage of biomarkers for neuroprognostication is that the can be assessed blindly, thus avoiding the risk of a self-fulfilling prophecy. Another recent advance in post-CA neuroprognostication is automated pupillometry (AP). This technology is quantitative, more precise than standard pupillometry (SP) and it can also be evaluated blindly. In a recent multicentre study comparing AP with SP, AP predicted unfavourable outcome with 0% false positive rate as early as 24 h after CA, while SP provided a late and less precise prediction. Another multicentre prognostication study showed that fractional anisotropy (WWM-FA) measured on magnetic resonance imaging can accurately predict poor neurological outcome at 6 months in resuscitated patients with prolonged unconsciousness (≥7 days) after CA. This tool can be particularly suitable to rule out late awakening after resuscitation.