Thermoregulate, autoregulate and ventilate: Brain-directed critical care for pediatric cardiac arrest

Jonathan E. Kurz, Craig M. Smith, Mark S. Wainwright*

*Corresponding author for this work

Research output: Contribution to journalReview article

Abstract

Purpose of review Cardiac arrest in childhood is associated with a high risk for mortality and poor long-term functional outcome. This review discusses the current evidence for neuroprotective therapies and goals for postarrest care in the context of the pathophysiology of hypoxic-ischemic injury, modalities for neurologic prognostication in these children and potential future monitoring paradigms for maximizing cerebral perfusion in the postarrest period. Recent findings The recent publication of the in-hospital and out-of-hospital Therapeutic Hypothermia After Cardiac Arrest trials demonstrated a lack of statistically significant benefit for the use of postarrest therapeutic hypothermia. As a result, targeted normothermic temperature management has become standard of care. Continuous electroencephalographic monitoring during the acute postarrest period provides useful additional data for neurologic prognostication, in addition to its value for detection of seizures. Ongoing research into noninvasive monitoring of cerebrovascular autoregulation has the potential to individualize blood pressure goals in the postarrest period, maximizing cerebral perfusion in these patients. Summary Therapeutic strategies after cardiac arrest seek to maximize cerebral perfusion while mitigating the effects of secondary brain injury and loss of autoregulation. Future research into new monitoring strategies and better long-term outcome measures may allow more precise targeting of therapies to these goals.

Original languageEnglish (US)
Pages (from-to)259-265
Number of pages7
JournalCurrent opinion in pediatrics
Volume29
Issue number3
DOIs
StatePublished - Jun 1 2017

Keywords

  • autoregulation
  • brain injury
  • electroencephalogram
  • hypoxia-ischemia
  • therapeutic hypothermia

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

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