Critical Care Refresher Course: Acute Circulatory Failure

Life-threatening arrhythmias in ICU (Maggiorini)

Narrow vs wide classification is a good framework to build on

Revisit the pathophysiology!

Always start with the patient – have a system for evaluating and assessing the patient AND ECG

Most anti-arrhythmic drugs have pro-arrhythmic effect

ICDs saves more lives than amiodarone in stable patients with heart failure

References

Supraventricular tachycardia: implications for intensivists

2003 ESC guidelines for management of tachycardias

ICDs vs amiodarone

 

Cardiac arrest: Management and post-resuscitation care (Sunde)

Death is a protracted pathophysiological process, not a moment – P Safer

Post cardiac arrest syndrome – underlying cause AMI/CHD; ischaemic/reperfusion syndrome – primary (arrest and during CPR) and secondary ischaemic damage; SIRS

Post resuscitation care – optimising physiology;

  • temperature
  • BP (brain) – vasopressor, fluids, inotropes
  • myocardial dysfunction
  • acid-base
  • blood glucose – < 10mM
  • oxygenation/ventilation
  • electrolytes
  • anticonvulsants – detect and treat early

Active optimal and standardised treatment

  • Coronory angiography/PCI – even PEA/asystole , a significant proportion will have lesions amenable to PCI
  • Temperature – avoid fever but probably not a one size fits all
  • Haemodynamics – the optimal MAP and vasopressor requirements are affected by temperature management; bradycardia associated with better outcomes
  • Prognostication – multimodal approach required

References

Hospital care of cardiac arrest patients matter

Post cardiac arrest syndrome

A bundle for post cardiac arrest management in Oslo

Bradycardias associated with better outcomes

Neurological prognostication guidelines

 

Ethical dilemmas: Communication and decision making during CPR (Csomos)

Perimortem caesarean delivery – consider within 5 minutes!

If family are present during arrest resuscitation, have a dedicated member of staff look after them.

Have a structured communication plan – SBAR or RSVP

Skill and experience should take over seniority

References

Cardiac arrest in special circumstances

Canadian statement on family presence during resuscitation (2015)

SBAR for communication

Would patient survive cardiac arrest?