Cardiac Arrest and Post-Arrest Management

Cardiac arrest is an exquisitely time-sensitive critical illness that strikes over 400,000 people each year in the United States. Initial treatment is based on the “chain of survival,” a paradigm described by the American Heart Association that includes prompt recognition of cardiac arrest, early delivery of cardiopulmonary resuscitation, use of defibrillation when appropriate, followed by advanced care in the hospital for those who attain return of spontaneous circulation (ROSC). Hospital-based care for patients with ROSC includes the use of careful neurologic monitoring including electroencephalography, hemodynamic support to maintain adequate brain perfusion, careful oxygen titration, and the use of targeted temperature management (TTM), either to a cooled state such as 33 °C or at a very minimum to a strict avoidance of fever (i.e., TTM technology employed to maintain strict normothermia). The goal of hospital-based critical care for post-arrest patients is to minimize the risk of crippling neurologic injury, which can occur as a component of post-cardiac arrest syndrome, an overlapping set of pathophysiologic processes that are activated in the first few days following resuscitation. This chapter will review current understandings of TTM, neurologic monitoring, and related topics pertaining to post-arrest care.