Author: Ecccp@scribe

Invitation to participate in the ICU Hypotension Survey

Ecccp@scribe Critical care , ,

Invitation to participate in the ICU Hypotension Survey

Hello member society

The WFICC Council recently approved a request for in-principle support for an ICU Hypotension Survey. This is an International Survey conducted among Physicians and Nurses regarding Used Definitions, Incidence, Current Treatment Strategies and Perceived Outcome of Hypotension in Intensive Care Patients.

The lack of consensus regarding an universal definition of hypotension for ICU patients and the need of being proactive rather than reactive towards hypotensive episodes formed a trigger to develop an international survey to map used definitions, treatment and outcome of hypotensive episodes in the ICU among physicians and non-physicians. The aim of this survey is to form a baseline on these topics. Besides, the results of the survey are expected to improve future guidelines, patient care and guide new topics for research. This survey is endorsed by the Executive Committee and the Cardiovascular Dynamics Section of the European Society of Intensive Care Medicine and is supported by the World Federation of Intensive and Critical care.

Please encourage your members to participate

If you are an ICU based physician or non-physician, the WFICC is supporting  a request for your participation. This anonymized survey will take 10 to 15 minutes to complete. Please respond from the perspective of standard practice in your ICU.

Complete the survey here: https://nl.surveymonkey.com/r/3CJCJV9

If you have any questions about the survey, please contact: w.h.vanderven@amsterdamumc.nl

On behalf of the WFICC Council, thank you very much for assisting with the dissemination of the survey and for encouraging the contribution of your members.

Kind regards and best wishes,

Phil Taylor

Chief Executive Officer – WFICC

Web: www.wficc.com

Therapeutic strategies in managing cardiac arrest

Ecccp@scribe Critical care, Newsletter , ,

Therapeutic strategies in managing cardiac arrest

  • Updated resuscitation guidelines emphasize the need for minimally interrupted high quality chest compressions as a prerequisite for successful resuscitation outcome.
  • Resuscitation involves the integration of complex systems and the interdisciplinary coordination of multispecialty emergency and critical care providers.
  • The immediate period following return of spontaneous circulation (ROSC) is crucial and is dominated by the presence of two critical goals- identification of pathophysiological cause, and the assessment and initiation of time- dependent interventions, directed at preventing recurrent arrest, and improving immediate and long- term outcome.
  • There is no vasopressor or anti-arrhythmic agent whose use is associated with improved outcome at discharge. In-hospital resuscitation should focus on the provision of high quality chest compressions and the search for immediate treatable precipitants of the arrest in those patients who achieve ROSC.
  • A systematic checklist may aid in the systematic evaluation of patients following ROSC.

Management after resuscitation from cardiac arrest

  • Following return of spontaneous circulation, the quality of the treatment provided in the post-arrest period influences outcome.
  • Most patients resuscitated after a prolonged period of cardiac arrest will develop the post-cardiac arrest syndrome.
  • All survivors of out-of-hospital cardiac arrest should be considered for urgent coronary angiography unless the cause of cardiac arrest was clearly non-cardiac or continued treatment is considered futile.
  • Several interventions may impact on neurological out-come, the most significant of these is targeted temperature management.
  • In patients remaining comatose after resuscitation from cardiac arrest, prediction of the final outcome in the first few days may be unreliable. Prognostication should normally be delayed until at least 3 days after return to normothermia and should involve more than one than one mode (e.g. clinical examination combined with another investigation).

Key components of the post-cardiac arrest syndrome.

  • Post- cardiac arrest brain injury- this manifests as coma and seizures.
  • Post- cardiac-arrest myocardial dysfunction –this can be severe and usually recovers after 48 hours.
  • Systemic ischemia/reperfusion response –tissue reperfusion can cause programmed cell death (apoptosis) effecting all organ systems.
  • Persisting precipitating pathology-coronary artery disease is the commonest precipitating cause after OHCA

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