The Critical Care Commute Podcast Clinical Practice Update on Optimal Post Cardiac Arrest and Refractory Cardiac Arrest Patient Care with Dr Janek Senaratne.
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Jan 23, 2025 Dr. Janek Senaratne, a dual-trained cardiologist and intensivist from Edmonton, shares cutting-edge insights on post-cardiac arrest care. He discusses the recently published Canadian guidelines, emphasizing the necessity for standardized management to enhance patient outcomes. Key strategies like the role of coronary angiography, temperature control, and effective decision-making are explored. Dr. Senaratne also touches on critical management strategies in the first 72 hours post-arrest, focusing on individualized treatment approaches and recent trial findings on oxygen and CO2 management.
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Strong Evidence Base
- The clinical practice update (CPU) recommendations are based solely on randomized control trials.
- No recommendations rely on case series, reports, or observational data, ensuring robust evidence.
Delay Angiography Without STEMI
- For cardiac arrest without STEMI, delaying coronary angiography is reasonable since early cath shows no survival benefit.
- Immediate angiography remains indicated for STEMI or high-risk cardiac features like severe ST depression or hemodynamic instability.
Temperature Control Nuances
- Start temperature control only in patients who do not purposefully follow verbal commands, and only in-hospital.
- Target normothermia (≤37.5°C), preventing fever rather than aggressive hypothermia, maintained for 72 hours.