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Targeted Temperature Management and Multimodality Monitoring of Comatose Patients After Cardiac Arrest
- Source :
- Frontiers in Neurology, Frontiers in Neurology, Vol 9 (2018)
- Publication Year :
- 2018
- Publisher :
- Frontiers Media S.A., 2018.
-
Abstract
- Out-of-hospital cardiac arrest (CA) remains a leading cause of sudden morbidity and mortality; however, outcomes have continued to improve in the era of targeted temperature management (TTM). In this review, we highlight the clinical use of TTM, and provide an updated summary of multimodality monitoring possible in a modern ICU. TTM is neuroprotective for survivors of CA by inhibiting multiple pathophysiologic processes caused by anoxic brain injury, with a final common pathway of neuronal death. Current guidelines recommend the use of TTM for out-of-hospital CA survivors who present with a shockable rhythm. Further studies are being completed to determine the optimal timing, depth and duration of hypothermia to optimize patient outcomes. Although a multidisciplinary approach is necessary in the CA population, neurologists and neurointensivists are central in selecting TTM candidates and guiding patient care and prognostic evaluation. Established prognostic tools include clinal exam, SSEP, EEG and MR imaging, while functional MRI and invasive monitoring is not validated to improve outcomes in CA or aid in prognosis. We recommend that an evidence-based TTM and prognostication algorithm be locally implemented, based on each institution's resources and limitations. Given the high incidence of CA and difficulty in predicting outcomes, further study is urgently needed to determine the utility of more recent multimodality devices and studies.
- Subjects :
- medicine.medical_specialty
medicine.medical_treatment
Population
cardiac arrest
Electroencephalography
Targeted temperature management
targeted temperature management
lcsh:RC346-429
Patient care
Multimodality
03 medical and health sciences
0302 clinical medicine
Internal medicine
anoxic brain injury
medicine
EEG
Intensive care medicine
education
Anoxic brain injury
lcsh:Neurology. Diseases of the nervous system
education.field_of_study
medicine.diagnostic_test
business.industry
Correction
030208 emergency & critical care medicine
Shockable rhythm
Mr imaging
multimodality monitoring
Neurology
Cardiology
Neurology (clinical)
High incidence
prognosis
business
030217 neurology & neurosurgery
Subjects
Details
- Language :
- English
- ISSN :
- 16642295
- Volume :
- 9
- Database :
- OpenAIRE
- Journal :
- Frontiers in Neurology
- Accession number :
- edsair.doi.dedup.....278a7ca4fe7e56a53db9c8b030d75bd6