In previous pearls, Dr. Marcolini has highlighted the poscardiac arrest syndrome (PCAS), comprised of brain injury, myocardial dysfunction, systemic ischemia/reperfusion response, and persistent precipitating disease.
Not surprisingly, postcardiac arrest brain injury is a major cause of morbidity and mortality, accounting for > 60% of deaths in some studies.
In addition to therapeutic hypothermia, consider "controlled reoxygenation" in order to optimize neurologic outcome.
Animal data has demonstrated that too much oxygen may worsen neuronal damage during the initial resuscitation phase.
Take Home Points:
Use a minimum amount of FiO2 to maintain SpO2 of 94-96%
Avoid unnecessary arterial hyperoxia
References
Nolan JP, Soar J. Postresuscitation care: entering a new era. Curr Opin Crit Care 2010;16:216-22.
