brain injury

AAN: Guidelines for Reducing Brain Injury Following Resuscitation

The American Academy of Neurology recently released new guidelines for the management of patients who are comatose after successful cardiopulmonary resuscitation.

“Multiple brain-related complications such as seizures, status epilepticus, myoclonus, and cerebral edema can occur in patients post arrest,” the authors wrote.
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A panel of experts updated the guidelines based on published literature from 1966 to August 29, 2016, and classified evidence accordingly in order to improve care for patients who are comatose after resuscitation and reduce the risk for possible neurological complications.

Among the recommendations:

  • Therapeutic hypothermia is highly likely to improve functional neurological outcomes and survival, and is recommended for patients who are comatose after an out-of-hospital cardiac arrest with an initial cardiac rhythm that is either pulseless ventricular tachycardia (VT) or ventricular fibrillation (VF).
  • Targeted temperature management is an acceptable alternative to therapeutic hypothermia for patients who are comatose with an initial cardiac rhythm that is either VT/VF or asystole/pulseless electrical activity (PEA) after an out-of-hospital cardiac arrest.
  • Survival and functional neurologic outcomes at discharge for patients who are comatose with an initial PEA/asystole may be improved by therapeutic hypothermia compared with standard care.
  • Prehospital cooling should not be offered as an adjunct to therapeutic hypothermia as it is most likely to be ineffective at improving neurological outcomes and survival.

In addition, the guidelines include pharmacologic treatments and evidence regarding the use of oxygen therapy for patients who are comatose following successful cardiopulmonary resuscitation after a cardiac arrest.

—Melissa Weiss

Reference:

Geocadin RG, Wijdicks E, Armstrong MJ, et al. Practice guideline summary: Reducing brain injury following cardiopulmonary resuscitation [published ahead of print May 10, 2017]. Neurology. doi:10.1212/WNL.0000000000003966.