Changes in icp following response checking in icu

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All India Institute of Medical Sciences

Health & Medicine Technology

Anjusha T ,Deepak Agrawal Department of Neurosurgery JPN Apex Trauma Centre, AIIMS, New Delhi

BACKGROUND OF THE STUDY ,[object Object],[object Object]

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Don't Forget A & B! Over 500,000 patients per year suffer sudden cardiac arrest. Despite advances in our understanding and management of cardiac arrest, less than 15% of patients survive to hospital discharge with meaningful neurologic survival. In recent years, the focus of cardiac arrest resuscitation has been the delivery of high-quality chest compressions and early defibrillation for those with a shockable rhythm. As a result, airway interventions and ventilation now follow attempts to optimize circulation in cardiac arrest patients. Though high-quality CPR and early defibrillation are essential in the initial stages of resuscitation, advanced airway placement and appropriate ventilation are critical to overall patient survival. Dr. Winters' discusses the current literature on the timing of advanced airway placement, oxygenation, and ventilation for the cardiac arrest patient. In addition, he discusses optimal targets for oxygenation and ventilation in the patient with return of spontaneous circulation from sudden cardiac arrest.

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Patients admitted to the ICU after cardiac arrest have, by definition, achieved ROSC. In such patients the major issues remain those of ongoing support hemodynamic and cardiorespiratory support, cerebral protection, aetiological diagnosis, and rapid intervention to deal with the underlying trigger (coronary angiography and stenting of coronary artery disease or CT pulmonary angiography and anticoagulation/thrombolysis for PE). Once the aetiological diagnosis has been made and its cases addresses and cardiovascular stability has been achieved, the priority of care is directed toward cerebral protection. Previous randomized controlled trials had suggested that hypothermia would deliver superior neurological outcomes compared to usual care. However, methodological concerns led to a further large trial of strict normothermia (TTM-1) which found strict normothermia to be equivalent to hypothermia in terms of neurological outcomes. Such findings have led to the design and randomization of patients with out of hospital cardiac arrest (OOHCA) to normothermia vs. avoidance of fever (TTM-2). At the same time preliminary work has demonstrated the potential of hypercapnia to act as a cerebral protector in patients with OOHCA. His has now led to a large trail called TAME, which currently also recruiting patients worldwide and in ANZ. These two trials will provide important information on the outcome of OOHCA patients and may identify new ways of achieving cerebral protection in this setting.

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