Edited by Professor Jerry P. Nolan
For several decades survival rates following out-of-hospital cardiac arrest (OHCA) have remained disappointing low; however, over the last 5 years many centres around the world are documenting increasing long-term survival rates, particularly after OHCA with an initial shockable rhythm. Improvements in the community response to OHCA, including increasing rates of bystander cardiopulmonary resuscitation (CPR) and defibrillation have resulted in more cardiac arrest patients achieving return of spontaneous circulation (ROSC) and being admitted to hospital. Most of these patients are initially comatose and many develop the post-cardiac arrest syndrome and require multiple organ support on the intensive care unit (ICU). Thus, they present an increasing workload for intensive care clinicians worldwide.
In recognition of the importance of cardiac arrest to intensive care clinicians, Critical Care is publishing four narrative reviews linked under the theme of CPR. The optimal method for managing the airway and ventilation during cardiac arrest is controversial and the review on this topic will explore the current issues and possible solutions. Several randomised controlled trials have been completed in an attempt to define the role of mechanical devices during CPR – a review of this topic explains the risks and benefits of these devices and outlines the indications for their use. Adrenaline has been central to the treatment of cardiac arrest since modern CPR was first described in the 1960s. Whether adrenaline is helpful or harmful during CPR is unclear and is discussed in a review of this topic. Finally, it is now recognised that patients initially comatose after being resuscitated from cardiac arrest may take many days to awaken. The ability to reliably prognosticate the ultimate outcome of comatose post-cardiac arrest patients is important to clinicians and patients’ families – a review of this topic brings the intensive care clinician up to date with the current multimodal approach to prognostication.