(精选)CBP Cardiac Arrest教学课件.pptVIP

CBP: Cardiac Arrest;Case Presentation;;;Question 1;Definition;Phases – for Therapy for Science;Pathophysiology;Forrest through the trees;Fundamentals;Question 2;;;;;;Question 3;Who should be cooled?;Bernard, 2002, NEJM;HACA, 2002, NEJM;What are the parameters of cooling protocol?;Complications of TH;;Should we cool this patient?;Question 4;. What do you tell them and how do you prognosticate patients post arrest? ;Timing;What is a poor outcome?;What is a poor outcome?;Clinical signs;Clinical Signs;;EEG;SSEP’s;N20;;Biomarkers;;Imaging;;;Question 5 ;Questions;Etiology of cardiac arrests;65-70 %;Etiology of Sudden Cardiac Death;Should he go to the cath lab?;1994-1998 Pt post cardiac arrest btw 30-75 Immediate cath if no obvious non-cardiac cause 1st rhythm recorded: 93% VF/VT 84% had 0 or 1 cardiac RF 71% had clinically significant CAD ;;Recommendations for cath post cardiac arrest;Recommendations;If he arrested again, would you thrombolyse him?;;TROICA (NEJM 2008) Tenecteplase vs placebo Stopped early for futility Lancet 2001 rt-PA vs placebo Improved ROSC but no difference in 24HR survival or survival to discharge AJC 2006 No statistically significant benefit;Treatment recommendation: “Fibrinolysis should be considered in adult patients with cardiac arrest with proven or suspected pulmonary embolism. There are insufficient data to support or refute the routine use of fibrinolysis in cardiac arrest from other causes.”;Question 6;;;Question 7;Question 8;Question 7: Indications for ICD implantation post-arrest;Indications for ICD;Question 8a: Are there any differences between in-hospital and out-of-hospital cardiac arrest? ;Differences between in-hospital and out-of-hospital cardiac arrests;Question 8b: What can be done to improve the outcome of in hospital cardiac arrest? ;“Survival” post in-hospital cardiac arrests;Strategies to improve outcomes;Strategies to improve outcomes;Strategies to improve outcomes;Strategies to improve outcomes;Active Compression/Decomp