Post-Cardiac Arrest Syndrome

Many patients who achieve restoration of spontaneous circulation (ROSC) following out-of-hospital SCA experience post-cardiac arrest syndrome. This combination of complex pathophysiologic processes develops during the human body’s recovery from prolonged whole body ischemia.¹³ This severe injury progresses because of interactions between an injured brain, heart, and other organs which can ultimately result in multisystem organ failure and death. Post-cardiac arrest syndrome may be worsened by the precipitating cause of the cardiac arrest.

Many of the components of post-cardiac arrest syndrome can be successfully treated. All SCA patients who survive to hospital admission should have the opportunity to benefit from state of the art care to treat possible post-cardiac arrest syndrome. If necessary, patients should be transferred to a critical care unit in an institution that is committed to providing the best possible care which will address all aspects of post-cardiac arrest syndrome.

There are many gaps in both the knowledge and delivery of post-cardiac arrest care. Optimal care for these patients has not been standardized. While regional systems of care have been proposed, they are not yet widely available. One example of a structure that is being explored as a model for a system of care for SCA patients is based on North Carolina’s RACE program. However, regional care protocals for these patients do not yet commonly exist. Many physicians who currently care for SCA survivors may be unfamiliar with post-cardiac arrest syndrome and do not have access to evidence-based treatment protocols.¹⁴

Objectives of Post–Cardiac Arrest Care

1. Optimize cardiopulmonary function and vital organ perfusion after ROSC

2. Transport/transfer to an appropriate hospital or critical care unit with a comprehensive post-cardiac arrest treatment system of care

3. Identify and treat ACS and other reversible causes

4. Control temperature to optimize neurologic recovery

5. Anticipate, treat, and prevent multiple organ dysfunction. This includes avoiding excessive ventilation and hyperoxia(Highlights of the 2010 American Heart Association Guidelines for CPR and ECC