In this episode, I’ll discuss the AHA/NCS scientific statement on critical care management of patients after cardiac arrest.
There is a lack of high-quality published research to support the critical care management of patients after cardiac arrest, and as a result there are few guideline recommendations in this area. In an attempt to bridge this gap the American Heart Association and Neurocritical Care Society have collaborated to publish a scientific statement using an expert consensus panel that included physicians, nurses, pharmacists, and a respiratory therapist.
The panel reached consensus on 4 statements related to sedation and analgesia in this patient population:
1. The goals of analgesia and sedation during temperature control after cardiac arrest are to provide comfort, to reduce shivering, and to prevent recall during neuromuscular blockade.
2. Short-acting sedative and analgesic agents are preferred for patients in post-cardiac arrest coma undergoing temperature control to reduce the duration of mechanical ventilation, time to awakening, and confounding of delayed prognostication.
3. Propofol, remifentanil, and fentanyl are favored over midazolam and morphine infusions.
4. Use neuromuscular blockers as needed during temperature control rather than as a continuous infusion. In addition, it is important to note that neuromuscular blockers may mask seizures in unmonitored patients.
It is important to note that because this is not a guideline supported by high-quality evidence, there are no recommendations made. Rather, these statements represent the consensus opinion of the expert panel. The authors ackowledge the limitations of such a document including a relatively small number of people providing input and the risk of persuasive voices influencing group thinking.
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