Actualités dans la prise en charge des patients admis en réanimation pour un arrêt cardiaque

Abstract

Cardiac arrest (CA) is the third leading cause of death in Europe, with a significant morbidity burden. The main cause of death is the discontinuation of treatment due to neurological sequelae or comorbidities. Management of the post-resuscitation syndrome is based on fluids and norepinephrine administration, with a target of mean arterial pressure >65mmHg. Respiratory management is based on oxygenation targets including pulsed oxygen saturation between 94% and 98% and arterial oxygen partial pressure between 75 and 100 mmHg and a normocapnia target. Active fever control (temperature >37.5°C) is recommended in all patients. Targeted temperature management (33°C or 36°C) might be considered in the most severe patients. Neuropronostication must be as reliable as possible. It must systematically be started early and be based on a multimodal clinical and paraclinical assessment of the patient in coma despite the discontinuation of sedation. The majority of patients discharged alive from hospital after a CA have a satisfactory neurological outcome, enabling them to return home, although more than a third have mild to moderate but potentially disabling cognitive and psychological sequelae.