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Semin Neurol 2006; 26(4): 396-402
DOI: 10.1055/s-2006-948320
Copyright © 2006 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA.

Postresuscitative Intensive Care: Neuroprotective Strategies after Cardiac Arrest

Wendy L. Wright1 , Romergryko G. Geocadin2
  • 1Departments of Neurology and Neurosurgery, Emory University Hospital, Atlanta, Georgia
  • 2Department of Neurology, Anesthesiology-Critical Care Medicine, and Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Publication History

Publication Date:
10 August 2006 (online)

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ABSTRACT

Cardiac arrest is a common disease in the United States, and many patients will die as a result of the neurological damage suffered during the anoxic period, or will live in a neurologically debilitated state. When cardiopulmonary-cerebral resuscitation results in the return of spontaneous circulation, intensive care is required to optimize neurological recovery. Such “brain-oriented” therapies include routine care, such as positioning and maintenance of volume status; optimization of cerebral perfusion, with the use of vasopressors if needed; management of increased intracranial pressure with agents such as hypertonic saline; assuring adequate oxygenation and avoiding hypercapnia; aggressive fever control; intensive glucose control, with the use of an insulin drip if needed; and management of seizures if they occur. To date, no neuroprotectant medications have been shown to improve neurological outcome. Induced moderate therapeutic hypothermia is utilized as a neuroprotective maneuver. Future treatment options and advanced monitoring techniques are also discussed. Further study to optimize neuroprotective strategies when treating patients who survive cardiac arrest is needed.

KEYWORDS

Postresuscitation - cardiopulmonary-cerebral resuscitation (CPCR) - cardiac arrest

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Wendy L WrightM.D. 

Assistant Professor, Neuroscience Critical Care and Cerebrovascular Disease, Departments of Neurology and Neurosurgery, Emory University Hospital

1365B Clifton Road, NE, Suite 2200, Atlanta, GA 30322

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