Post-resuscitation syndrome after cardiac arrest - protecting vital organs and individualizing treatment

Published on September 30, 2016   36 min

Other Talks in the Category: Clinical Medicine

0:00
Hi, my name is Dave Seder, I'm a Critical Care Specialist at Maine Medical Center in Tufts University in Portland, Maine. And I'm going to be speaking to you today about the "Post-Resuscitation Syndrome After Cardiac Arrest".
0:17
So, I'm gonna move on now, after talking about protecting the brain, to talking about protecting the heart.
0:23
So I'm gonna go back to this diagram of what patients die from after a cardiac arrest. And when I used to look at this slide, I saw the big blue slice that's hypoxic-ischemic encephalopathy, and I thought that it was important to put all of our eggs in that basket and work primarily on protecting the brain. But now I know that that's wrong! And that we really have to focus on all of these different categories and improve the treatment related to the brain, the heart, and the rest of the organs as best we can, to gain the best results in our patients. So these 23% or 26% of patients, dying from a circulatory etiology deaths, need to be directly addressed.
1:02
So we know from several studies that acute myocardial infarction or heart attacks are very common in patients who are resuscitated from a cardiac arrest. And that's primarily true in out-of-hospital cardiac arrest, but there is not an insignificant number of acute myocardial infarctions in patients who also undergo an in-hospital cardiac arrest. And if you look at the out-of-hospital cardiac arrest population, what turns out to be true, is that about half of the patients are having myocardial infarction; and somewhere between 25% and 35% overall have the need for urgent coronary revascularization. So the data on the right are from a large group of primary cardiac arrest centers in the United States, between 2003 and 2012. And what the investigators in the United States found was that about 80% of patients who have an ST elevation MI, who have clear evidence on their EKG when they come into the hospital having an acute heart attack, 80% of those patients, when they undergo urgent coronary angiography, will have a culprit lesion that needs to be revascularized. In patients who have a presumed cardiac cause of the arrest but do not have an ST elevation MI or obvious evidence of a transmural ongoing myocardial infarction on their electrocardiogram, 33% of those patients still have acute MI and require revascularization.
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Post-resuscitation syndrome after cardiac arrest - protecting vital organs and individualizing treatment

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