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9 Out-of-hospital cardiac arrest
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Published:February 2021
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This version:June 2023
Updated in this version:
Update:
The new European Resuscitation Council 2021 Advanced Life Support guidelines are included.
The new European Resuscitation Council and European Society of Intensive Care Medicine 2021 guidelines on post-resuscitation care have been incorporated into the text.
In the comatose post-cardiac arrest patient, temperature control to prevent fever is now preferred to hypothermic temperature control.
New studies on temperature control, blood pressure targets, and oxygenation targets have been included.
The section ‘Extracorporeal CPR’ has been updated to include recent clinical trials.
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Abstract
Cardiac arrest is the most extreme of medical emergencies. If the victim is to have any chance of high-quality neurological recovery, cardiac arrest must be diagnosed quickly, followed by summoning for help as basic life support (chest compressions and ventilations) is started. In most cases, the initial rhythm will be shockable, but this will have often deteriorated to a non-shockable rhythm by the time a monitor and/or defibrillator is applied. While basic life support will sustain some oxygen delivery to the heart and brain and will help to slow the rate of deterioration in these vital organs, it is important to achieve restoration of a spontaneous circulation as soon as possible (by defibrillation if the rhythm is shockable). Once return of spontaneous circulation is achieved, the quality of post-cardiac arrest management will influence the patient’s final neurological and cardiological outcome. These interventions aim to restore myocardial function and minimize neurological injury.
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