心搏骤停后综合征

Title: Post-Arrest Syndrome

题目：心搏骤停后综合征

Author 作者: Ben Lawner

1. Goal of post-arrest syndrome care is to mitigate:

心搏骤停后综合征的目的是减轻：

a. Injury to brain 脑损伤

b. Injury to heart 心脏损伤

c. Inflammatory mediators 炎性介质反应

2. Initiate therapeutic hypothermia (neuroprotective)

应用治疗性低温（神经保护）

3. Definitively control airway完全控制呼吸道

a. Intubate now if not already done during the code

如在抢救时没有插管，现在要做

b. Avoid hyperventilation 不要过度通气

c. Avoid hyperoxia (goal O2 saturation in low 90s)

避免过度给氧（保持氧饱和度在刚过90％）

4. Manage blood pressure控制血压

a. Invasive hemodynamic monitoring (arterial line) preferred

最好放置动脉导管以监测血液动力学指标

b. Goal MAP 80-90 理想平均动脉压为80－90

c. May require vasopressors 可使用升压剂

d. Critically important to avoid episodes of hypotension

防止低血压的发生是非常重要的

5. Treat underlying cause of arrest治疗造成心搏骤停的原因

a. If presumed cardiac cause, need to send patient to cath lab

如考虑是心脏因素，要将病人送到导管室

i. ***can still cool prior to/during cath lab***

在导管前或导管中都要保持低温

ii. 2013 STEMI guidelines consider it a Class I indication to cool and cath a post-arrest patient that has STEMI on ECG

2013年STEMI指南将有ECG显示STEMI的心搏骤停后病人的低温和导管治疗列为第一类适应症

6. Sedation & paralysis镇静和肌肉松弛

a. Shivering increases metabolic demand and heat production

颤抖会增加代谢和热的产生

b. If shivering, paralyze 一旦有颤抖，就要给肌松剂

c. Benzodiazepines can also help prevent shivering

苯二氮卓类可帮助防止颤抖

7. Seizure control癫痫的控制

a. Consider non-convulsive status, particularly if patient paralyzed

如病人处于瘫痪状态，要考虑有非抽搐癫痫

b. Consider continuous EEG 要考虑做脑电图

c. Liberal use of benzodiazepines or propofol can help prevent; not enough literature to support prophylactic anti-epileptics

苯二氮卓类和丙泊酚的适量使用会起到预防作用；没有文献支持抗癫痫预防性用药

d. If see seizure activity, treat aggressively 一旦见有癫痫活动，要积极处理

8. Glucose control血糖控制

a. Keep glucose in a “normal” range 保持血糖在正常范围

i. Probably “tight” glucose control is not necessary 不需要严格控制

b. Unclear what ideal numbers are 什么是理想的数字还不清楚

9. Prophylactic antibiotics? 预防性抗菌素？

Aspiration is very common, but aggressive empiric antibiotics not of benefit unless evidence of aspiration pneumonia on x-ray or clinically

误吸是非常常见的，如胸片或临床上没有吸入性肺炎的征象，积极使用抗菌素是无益的

10. Steroids? 激素？

a. No evidence to support routine use 无证据支持它的常规使用

b. Reasonable if regractory hypotention or history suggestive of adrenal insufficiency 在顽固性低血压或有肾上腺功能低下病史时，可考虑

11. Renal replacement therapy? 肾脏替代治疗？

a. No routine role for dialysis 不需要常规使用透析

b. Monitor electrolytes & urine output 监测电解质和尿量

Bottom Line 要点

1. Keep MAP>80, & monitor end-organ perfusion

维持平均动脉压高于80，监测各器官灌注

2. Initiate therapeutic hypothermia使用治疗性低温

3. Send to the cath lab if potential cardiac cause of arrest

如是心脏的原因，送导管室

Reference 参考文献:

Reynolds JC, Lawner BJ. Management of the post-cardiac arrest syndrome. Journal of Emergency Medicine 2012; 42:440-449.