Cardiopulmonary resuscitation and post-resuscitation care

The first international guidelines on resuscitation were published in 2000 by the International Liaison Committee on Resuscitation and subsequently revised in 2005 to reflect the available scientific evidence base. This article summarizes these major changes, all of which are relevant to anaesthetic and critical care practice. Effective chest compressions during cardiopulmonary resuscitation are the most important factor for improving survival from cardiac arrest. The management of advanced resuscitation such as defibrillation, drugs and airway management strategies has been altered to minimize interruptions to chest compressions. The guideline for defibrillation has changed from a three-stacked shock protocol to a one-shock with a biphasic waveform. The provision of post-resuscitation care can improve morbidity and possibly mortality, with recommendations being added to the 2005 guidelines. Therapeutic cooling of survivors of ventricular fibrillation to 32–34°C for 12–24 hours improves long-term neurological outcome. Other regimens such as control of blood glucose between 4 and 6 mmol/litre and organ-specific support in the intensive care environment are recommended. At present there is no reliable predictor available to determine prognosis immediately after the return of spontaneous circulation. Objective tests such as serum S- 100B and neurone-specific enolase proteins, cortical response to median nerve somatosensory-evoked potentials and electro-encephalography can assist in diagnosing hypoxic ischaemic encephalopathy. Because a definitive prognosis can be made only 48–72 hours after the event, the clinician must allow at least this amount of time for intensive therapy to have an effect.