Cardiac Arrest Management and Neurological Outcomes

Cardiac arrest represents the abrupt cessation of effective cardiac activity and remains a leading cause of death worldwide. Survival depends on a coordinated chain of interventions that begin with immediate recognition and prompt activation of emergency services. Early initiation of bystander cardiopulmonary resuscitation (CPR) and rapid defibrillation, where indicated, significantly improve the likelihood of return of spontaneous circulation (ROSC). Once spontaneous circulation is restored, post-resuscitation care focuses on stabilising haemodynamics, supporting ventilation and minimising secondary brain injury. Targeted temperature management and optimisation of oxygenation and carbon dioxide levels aim to attenuate the cascade of hypoxic–ischaemic brain injury that follows the initial insult. Advanced therapies such as extracorporeal cardiopulmonary resuscitation (eCPR) may be considered for selected patients with refractory arrest. Accurate prognostication of neurological outcome is crucial to guide ongoing care and counsel families; this relies on a multimodal approach combining clinical examination, neurophysiological monitoring and biomarker analysis. Collectively, these strategies span the pre-hospital and in-hospital phases, addressing both survival and the prevention of long-term cognitive and functional deficits.

Research from Nature Portfolio

No recent Nature Portfolio content available.

Cardiac Arrest Management and Neurological Outcomes publication trend

The graph below shows the total number of articles in cardiac arrest management and neurological outcomes across all publications each year (not limited to Nature Index journals).

Technical terms

Out-of-hospital cardiac arrest (OHCA): Sudden cessation of cardiac activity occurring outside a hospital setting.

Return of spontaneous circulation (ROSC): Restoration of a palpable pulse and effective blood flow following resuscitation efforts.

Targeted temperature management (TTM): Controlled cooling or warming of a patient’s body to reduce brain injury after cardiac arrest.

Extracorporeal cardiopulmonary resuscitation (eCPR): Use of extracorporeal membrane oxygenation to support circulation in refractory cardiac arrest.

Hypoxic–ischaemic brain injury (HIBI): Brain damage resulting from inadequate oxygen and blood flow during and after cardiac arrest.

References

1. The global survival rate among adult out-of-hospital cardiac arrest patients who received cardiopulmonary resuscitation: a systematic review and meta-analysis. Critical Care (2020).
2. Out-of-hospital cardiac arrest during the COVID-19 pandemic in Paris, France: a population-based, observational study. The Lancet Public Health (2020).
3. Characteristics Associated With Out-of-Hospital Cardiac Arrests and Resuscitations During the Novel Coronavirus Disease 2019 Pandemic in New York City. JAMA Cardiology (2020).
4. Clinical pathophysiology of hypoxic ischemic brain injury after cardiac arrest: a “two-hit” model. Critical Care (2017).
5. Prognostication after cardiac arrest. Critical Care (2018).