Clinical Practice Update on Optimal Post Cardiac Arrest and Refractory Cardiac Arrest Patient Care with Dr Janek Senaratne.
Jan 23, 2025
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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.
The podcast emphasizes the importance of evidence-based practices in post-cardiac arrest care, as highlighted by recent randomized control trials.
Dr. Senaratne discusses the need for tailored approaches in managing coronary angiography decisions post-arrest, balancing risks and timely interventions.
Deep dives
Clinical Practice Update Goals
The update seeks to standardize the management of post-cardiac arrest care in Canada, addressing regional variations that have existed since the previous update in 2017. Evidence from recent randomized control trials has significantly informed the recommendations, ensuring that they reflect the most current practices and findings. This systematic approach aims to provide clear guidelines on managing patients who experience cardiac arrest, whether in or out of the hospital. The emphasis on evidence-based practices allows healthcare providers to implement the most effective interventions for post-cardiac arrest patients.
Invasive Strategies in Cardiac Arrest
The discussion on early versus delayed coronary angiography for post-cardiac arrest patients highlights a critical decision-making area. Findings from trials such as COACT and Tomahawk suggest that early invasive strategies may not be necessary for patients without ST-elevation myocardial infarction (STEMI), as outcomes did not significantly differ compared to delayed angiography. Consequently, it is important to consult with cardiology when determining the need for coronary angiography, taking the patient's clinical context into account. This tailored approach balances the risks of unnecessary procedures against the necessity of timely interventions.
Temperature Control Protocols
The clinical practice update underscores the importance of targeted temperature management, specifically focusing on patients who exhibit no purposeful movement following cardiac arrest. Based on evidence from the TTM2 trial, the update stipulates that temperature control should commence in-hospital and targets a normothermic range, specifically under 37.5 degrees Celsius. This refined approach aims to avoid the complications associated with aggressive cooling methods while still protecting neurological integrity. By preventing hypothermia and minimizing sedation, clinicians can enhance their capacity for effective neuroprognostication.
Key Considerations in Post-Cardiac Arrest Care
The update discusses critical components such as blood pressure targets and the management of oxygen and carbon dioxide levels in post-cardiac arrest care. It recommends maintaining mean arterial pressure (MAP) at or above 65 mmHg to protect vital organ function and outlines specific strategies for oxygen management, aiming to avoid hypoxemia and hyperoxemia. Additionally, considerations for antibiotic and anti-seizure prophylaxis focus on reserving treatment for clinically indicated cases rather than routine administration. These recommendations strive to optimize patient outcomes while minimizing unnecessary interventions.
Welcome to our first episode in a series on Cardiac Intensive Care, recorded live at the Critical Care Canada Forum 2024. We kick off by looking at the latest Clinical Practice Update on post cardiac arrest care and refractory cardiac arrest.
The "Canadian Cardiovascular Society/Canadian Cardiovascular Critical Care Society/Canadian Association of Interventional Cardiology Clinical Practice Update on Optimal Post Cardiac Arrest and Refractory Cardiac Arrest Patient Care" CCS was published in 2024, and provides comprehensive recommendations for the management of patients following cardiac arrest.
Join us as Dr Janek Senaratne unpacks this Clinical Practice Update (CPU), and guides us through the evidence for the recommendations made.
Dr. Janek Senaratne is a dual-trained cardiologist and intensivist based in Edmonton, Alberta. He serves as an Associate Clinical Professor in the Department of Medicine at the University of Alberta. University of Alberta In his clinical roles, Dr. Senaratne practices at the University of Alberta Hospital and Grey Nuns Hospital, and is one of the Vital Heart Response physicians for the province.
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