Key Updates and Recommendations on Cardiac Arrest Management (ILCOR 2024)
AbdolGhader Pakniyat
Emergency Medicine Specialist | Critical Care & Trauma Expert | POCUS Advocate | 13+ Years Experience | Assistant Professor, MUK | SPI ARDMS Certified | European Board Examination in Emergency Medicine- Part A
1. Should We Use ECPR?
Recommendation:?Use Extracorporeal Cardiopulmonary Resuscitation (ECPR) only when regular CPR does not work and only in hospitals with established programs.
-?Evidence:?The evidence is weak, and we are still very unsure about it.
-?2024 Status:?This recommendation remains the same as in 2023; we still lack strong evidence for consistent effectiveness.
2. Target Blood Pressure After Resuscitation:
Recommendation:?Aim for a mean arterial pressure (MAP) of 60–65 mm Hg after cardiac arrest.
-?Evidence:?There is no strong proof that improved blood pressure enhances survival or outcomes.
- This recommendation is based on expert opinions and common practices in other critical medical situations.
-?2024 Update:?This is a new recommendation; earlier guidelines did not specify a target blood pressure.
3. Cardiac Arrest During Pregnancy:
-?left Lateral Uterine Displacement (LLUD):
- There is no strong evidence, but it is safe to try.
-?Perimortem Cesarean (Resuscitative Hysterotomy):
- This procedure is recommended for pregnant women in advanced pregnancy during cardiac arrest.
- The sooner the baby is delivered, the better the chances of survival for both mother and child.
- There is no specific time limit; quicker delivery is always better.
-?ECPR in Pregnancy:
- This may be considered if standard CPR fails and the facility is equipped.
Key Takeaways:
1. ECPR: Only for cases where CPR does not work, and only in well-equipped hospitals.
2. After Resuscitation BP: Keep the MAP between 60–65 mm Hg.
3. Cardiac Arrest in Pregnancy: Focus on fast delivery (C-section) to improve survival for both the mother and baby. Consider ECPR if CPR does not work.
This is useful. Though generally I agree the studies of ECPR do not provide high level evidence; however the main issue with ECPR is that it is not something that is a universally applicable single intervention…it can benefit a small number of patients but needs a very strong system of care, and this makes it difficult to tease out which individual components are responsible for improved outcomes.
Thank you for posting this article with tips on cardiac arrest management.