Arrt Cardiorespiratoire chez ladultevidence de Science 2005Prof. Pierre MOLSCHU Saint-PierreBruxellesSminaire des Urgences IRIS 12 avril 2005

GnralitsArrt cardiaque extra-hospitalier ou out-of-hospital cardiac arrest ( OHCA)Incidence: 1/1000 habitants par antiologies OHCA: 80% cardiaques; 20% non cardiaquesCaractristiques:2 hommes/1femmeDomicile 75-80%RCP prcoce 10-50%Age augmente?Rythme de prsentation

Registre de la Province dAnvers

Grafiek1

0.2860.20.5140

0.3670.3670.2650

0.1960.4130.3910

0.2790.4120.3090

0.250.4210.3290

0.3270.2550.4180

0.2820.4230.2950

0.190.5690.2330

0.2590.4420.2990

0.260.460.280

0.1860.5480.2660

0.1830.450.3670

0.2420.4490.3080

PEA

Asystolie

VF

VT

jaar

percentage

Eerste hartritme ECG AED (n=1164)

Blad1

JAARTotal

199119921993199419951996199719981999200020012002

eerste ritme (AED)OverigeCount101818191918222238523511282

% within JAAR28.60%36.70%19.60%27.90%25.00%32.70%28.20%19.00%25.90%26.00%18.60%18.30%24.20%

AsystolieCount718382832143366659210327523

% within JAAR20.00%36.70%41.30%41.20%42.10%25.50%42.30%56.90%44.20%46.00%54.80%45.00%44.90%

VFCount181336212523232744565022358

% within JAAR51.40%26.50%39.10%30.90%32.90%41.80%29.50%23.30%29.90%28.00%26.60%36.70%30.80%

VTCount11

% within JAAR0.90%0.10%

TotalCount35499268765578116147200188601164

% within JAAR100.00%100.00%100.00%100.00%100.00%100.00%100.00%100.00%100.00%100.00%100.00%100.00%100.00%

199119921993199419951996199719981999200020012002Totaal

PEA28.60%36.70%19.60%27.90%25.00%32.70%28.20%19.00%25.90%26.00%18.60%18.30%24.20%

Asystolie20.00%36.70%41.30%41.20%42.10%25.50%42.30%56.90%44.20%46.00%54.80%45.00%44.90%

VF51.40%26.50%39.10%30.90%32.90%41.80%29.50%23.30%29.90%28.00%26.60%36.70%30.80%

VT0.00%0.00%0.00%0.00%0.00%0.00%0.00%0.00%0.00%0.00%0.00%0.00%0.00%

Blad1

PEA

Asystolie

VF

VT

jaar

percentage

Eerste hartritme ECG AED (n=1164)

Blad2

Blad3

Chane de SurvieCummins et al., Circulation 1991

1er maillon

Alerte immdiate (Early access)

Lalerte immdiate (Early access)Prsence dun tmoin Constat de la gravit de la situation(tat de mort apparente)Appel des SecoursEnvoi des secours approprisComplexeMultiples intervenantsNon professionnels et professionnels

Constat de la gravit de la situationFamilleStressReconnatre tat de mort apparente (Conscience 0, Respiration 0, Circulation 0)Appeler le bon secours (pas MT, famille mais le 112)Tmoin, non professionnel900 > 100 > 112

Appel des Secours n dappel unique (112)Contrainte technologiqueMessage clair et concisRgulation mdicale adquateEU112F15,18B100GB999E66NL6666OK sauf en BDlai 100-1re sonnerie13 s (7-33)Mortalit de 10% par minute qui scoule partir de t0SidentifierSe localiserDcrire la situationFaciliter larrive des secours Localisation de lappelautomatique

Rgulation mdicaleFormation mdicale de base du rgulateurFormation spcifique la rgulation mdicale par tlphoneInterrogatoire protocolis (inconscient, difficult respiratoire, douleur thoracique, chute dune grande hauteur, accident voie publique, )RCP par tlphoneILCOR Resuscitation 2000, 46: 29-71

Influence de la prcocit laccs sur la survie P.Mols et al. Resuscitation, 1994x + ESMn = 554

CPR instruction via telephone. Carter WB Ann Emerg Med 1984 Faisable% bystander-initiated CPR

Eisemberg MS Am J Public Health 1985

Culley LL Ann Emerg Med 1991

DlaisReconnatre ACRFaites une CPRVentilationcompressionCulley LL Ann Emerg Med 1991

45 56%

32% 1976-8154% 1982-88

75s19s25s30sRCP par tlphone2,3 min

Evaluation of dispatcher-assisted cardiopulmonary resuscitation. survieT-RCPRCPconnue - 7%T-RCPRCPconnue + 18%T-RCPabandonne 5%T-RCPconseils dclinsRCPconnue + 11%T-RCPconseils dclins autres raisons 3%T-RCPnon proposes 1%Bang A Eur J Emerg Med 1999 n = 427

CPR by chest compression alone or with mouth-to-mouth ventilation. Etude prospective et randomiseSuspicion ACR

Message T RCP Standard (G1)possible 62% T Compressions seules (G2)possible 81% p

2me maillon

RCP prcoceEarly CPR

Knickerbocker (1)Kouwenhoven (2)Jude (3)123Introduction du MCE et de la dfibrillation externe

Recommandations 2000-2005Appel rapide chez lenfant, le noy, le trauma, intoxication mdicamenteuse sinon Call First

Bilan Primaire: pour les non professionnels A, B et Signes de Circulation

Rescue Breathing(RB):Chest Compression (CC) 2:52:15

Volumes de ventilation au masque: 700-1000 ml air en 2 sec ou 400-600ml O2 en 1-2 sec

Nouvelles techniques de massage cardiaque externe

Handle - provides convenient grip to deliver compressions and decompressionsSuction Cup - with lip seal that adapts and adheres to uneven shape of chestMetronome - to monitor correct compression and decompression frequencyForce Gauge - guides proper compression and decompression forces during use

Survie ACD S CPR0510152025303540ROSC1 HourICUAdmit24HourHospDis1 YearSTD (377)ACD (373)Percent** p = 0.03Plaisance P, NEJM, 1999

Adverse hemodynamic effects of interrupting chest compressions for rescue breathing during CPR for VF cardiac arrest.Analyse de leffet dltre dune RCP standard (CC 15:RB 2; Hz 100/min) versus CC seules (Hz 100/min)

14 cochons de 32 kg

Induction VF, 3 min sans traitement

Priode dobservation 12 minutesBerg RA, et al.Circulation 2001; 104: 2465-70

Berg RA, et al. Circulation 2001; 104: 2465-70

Berg RA, et al. Circulation 2001; 104: 2465-70

Berg RA, et al. Circulation 2001; 104: 2465-70

Berg RA, et al. Circulation 2001; 104: 2465-70Blood FlowDO22-5 min9-12 min

Single-rescuer CPR Two quick breath - an oxymoromHeindenreich J. W. et alResuscitation 2004; 62: 283-289Uninterrupted Chest Compression

Similar results at 6 monthsHeindenreich J. W. et alResuscitation 2004; 62: 283-289

Heindenreich J. W. et alResuscitation 2004; 62: 283-289

113+/-291+/-443+/-149+/-2N = 53MD students

Mouth to mouth by the lay people?Yes of No2 quick breaths = 12 16 sHeindenreich J. W. et al, Resuscitation 2004; 62: 283-289Kern KB et al, Circulation 2002; 105: 645-9

Reluctance to perform early CPR

Willingness to perform CPR if no M to M is suppressed26 to 83% Medical studentsBrenner BE, et al Arch Int Med 1993; 153:1763-9

15 to 68 % Lay personLocke CJ et alArch Int Med 1995; 155:938-43

Patient PortSafety check valve -set to open at 22 cm H20should the patient regainspontaneous ventilationSilicone diaphragm -occludes the airwayduring the decompressionphase of CPRFilter -to prevent ventilationbag from viral andbacterial contaminationVentilation PortThe ResQ-Valve ITVis a single-use non-sterilevalve that is easily inserted into any standard respiratory system between the ventilationbag and endotracheal tube,face mask, Combitubeor laryngeal mask airway

PIT PIT PIT PITDecompression

Compression

End-Tidal CO246810121416182022051015202530Duration of CPR (minutes)Without ValveWith Valven=10n=11n=11n=9n=8n=11n=10n=10n=10n=8n=10n=7468101214161820220510152025Time (min)24n=10End-TidalCO2Plaisance et al, Circulation March, 2000

Aortic Diastolic Pressure304050607010152025Time (min)AorticDiastolic Pressure(mm Hg)20304050601015202530Without ValveWith Valven=8n=8n=7Duration of CPR (minutes)n=10AorticDiastolicPressure(mmHg)Plaisance et al, Circulation March, 2000

Coronary Perfusion Pressure10203040506010152025Time (min)15202530354045501015202530Without ValveWith ValveDuration of CPR (minutes)n=11n=10n=9n=8n=7n=10n=8n=10n=10n=10CPP(mmHg)CoronaryPerfusionPressure(mmHg)Plaisance P, Circulation, 2000

Evaluation of LUCAS, a new device for automatic mechanical compression and active decompression resuscitation. nouvel appareil automatique de massage ACD ; HZ 100/min

6.5kg

Fonctionne au gaz

tude de faisabilit chez lhomme (n=20) trs positive

Cas rapport dune asystolie, ROSC en 3 min, rcupration neurologique intgrale

Steen S et al.Resuscitation. 2002 Dec;55(3):285-99.

LucasGrande tude multicentrique en cours en Europe

3me maillon

Dfibrillation prcoce

Comparons...

Choc Electrique ExterneDpolariser une masse critique de cellules cardiaques

Interrompre les nombreuses boucles de rentre lectrique

Permettre nouveau une activation synchrone du muscle cardiaque.

_1049606557.doc

1

2

THORAX

Dfibrillation biphasiqueSeuil dintensit plus basMoins dnergie ncessairePlus de scuritMoins de complicationsBatterie moins lourde Plus petite priode rfractaire

Biphasic and monophasic shocks for transthoracic defibrillation: a meta analysis of randomised controlled trialsFaddy S.C. et al Resuscitation 2003 58:9-161985-9/2002 Medline, EMBASE, Cochrane register

VF, sudden death, ECC, mono-biphasic

Randomised controlled trials

Humans

1st end point: % shock failure (As, persistent VF) 200J mono versus biphasic

2 nd end point : ST modifications (marker myocardial damage)

Results813 citations9 papers7 randomised trialsCathLab during electrophysiologic study398 patientsFaddy S.C. et al Resuscitation 2003 58:9-16

Efficacy 1st shok of reversing VF200J: monophasic versus biphasicAbsolute risk reductionFaddy S.C. et al Resuscitation 2003 58:9-16

Efficacy 1st shok of reversing VF200J monophasic versus lower energy biphasicRisk reductionFaddy S.C. et al Resuscitation 2003 58:9-16

ST Segment deflection in 2 studiesFaddy S.C. et al Resuscitation 2003 58:9-16

Multicenter, randomized, controlled trial of 150-J BTE versus 200- to 360-J MDS in the resuscitation of O-HCA victims. Schneider T, et alCirculation 2000 ; 102: 1780-7200 -360 J MDS versus 150J BTEOHCARandomised, prospective, non blinded

Results

Optimal Response to Cardiac Arrest study: Defibrillation Waveform Effects.Superior defibrillation efficacy and speed Superior % ROSCNo differences in % refibrillation in % survival>Martens PRResuscitation 2001; 49: 233-43

A prospective , randomised and blinded comparisonof 1st shock Success of monophasic and Biphasic wave form in OHCAvan Alem A.P., Koster R.WResuscitation 2003 58:17-24 200 j Wave forms OHCARandomisedDouble blind

Characteristics of VF patients

1st endpoint

Endpoints and patient outcome

Adverse effects of interrupting precordial compression during cardiopulmonary resuscitation. Durant procdure AED, lintervalle hands off est une perte de temps?

tude randomise

25 rats mles Sprague Dawle

Induction VF, perdure 4minutes

CEE immdiat ou aprs 10, 20, 30, 40 secondes

Analyse le nombre de RACS et la survie 24 et 48 heuresSato Y et al Crit Care Med 1997; 25: 733-6

Adverse effects of interrupting precordial compression during cardiopulmonary resuscitation. Sato Y et al Crit Care Med 1997; 25: 733-6

Interruption of cardiopulmonary resuscitation with the use of the automated external defibrillator in OHCA Mesure de lintervalle hands offMise en place DEA 4min 17s (31 1404 s)148 OHCA, RCP45%+/- 15% du temps de connection ou RACS99 OHCA (FV/TV), RCP 36%+/- 20 % du temps de connection ou RACSRACS immdiatement post CEE, 3/184RACS final 87/184

van Alem AP et al. Ann Emerg Med. 2003 Oct;42(4):449-57 Moins de 50 % du temps de connection au DEA est utilis la RCP, ceci est encore plus vrai en cas de FV/TVLes DEA doivent tre capables danalyser plus vite et garder leur efficienceLes algorithmes doivent tre plus adquatsLe premier intervenant doit tre mieux duqu

The critical importance of minimal delay between chest compressions and subsequent defibrillation: an haemodynamic explanationSteen S. et al.Resuscitation 2003; 58: 249-258

- Automatique- nergie: gaz comprims- Compression Dcompression Active- Libration des mainsFrquence des compressions normes ILCORVentilation significative Efficacit dmontre chez lanimaltudes cliniques OHCA en coursLucas

Dfibrillationjusquo prcoce

Dfibrillation, jusquo prcoceICU1950-1960ED1950-1960MICU1960-19701st tier1970-1980 (EMT, EMT-D)Professionnels non ambulanciers 1980-1990PAD1990, .NEJM 2004HATefficacy not yet proven

Outcomes of rapid defibrillation by security officers after cardiacGarde de scurit Casinos (surveillance tlvisuelle +++)153 ACR, 105 en FV, 56 survivantsDEA fonctionnels endans les 3 minutes Survie moyenne 53 % la sortie de lhpital Survie 74 % si 1er CEE < de 3 minutes.

Valenzuela TD, N Engl J Med 2000

Use of automated external defibrillators by a U.S. airline.Efficacit de la DEA par du personnel de cabine Vol ou au sol, avant ou aprs latterrissage avion14 patients en FV Survie la sortie de lhpital 40 %.Page RL, NEJM 2000

Public locations of cardiac arrest. Implications for public access defibrillation. Les appareils de DEA ne peuvent tre disposs au hasard dans la ville sans une apprciation du rapport de leur cot /risque dtre utilis en cas dACR ILCOR

1 fois tous les 5 ans Becker L, Circulation 1998

The PAD Trial Investigators NEJM 2004; 351:637-46Public Access Defibrillation an survival After Out-of-Hospital Cardiac Arrest

Public Access Defibrillation an survival After Out-of-Hospital Cardiac Arrest

CommentairesEffet bnfique sur le nombres de survivants dans le groupe PAD+ (X 2)Mais11015 volontaires forms RCP et DEA2095 DEA1822 alertes 260 AC dont 128 dorigine cardiaque 30 Survivants la sortie de lhpital

Localisation of OHCA in Gteborg 1994-2002 and implications for Public Access DefibrillationLocalisation 2194/2197 OCHA

Non accessible PAD 83%Domicile 65%Extrieur13%Automobile 3%

Accessible PAD 17%Nursing home 2%Btiment publique 7%Transport publique 1%Travail 1%Hpital sans dfib. 1%Care Facility 4%GP office 1%J. Engdahl, J HerltzResuscitation 2005; 65: 171-5

Lieu avec plus de un OCHA / 5ansPar 5 ans

Hpital de revalidation5H. Psychiatrique3.9Ferryboat3.1Gares2.2Police 2.2Centres de congrs1.7Petites structures de soins1.1Parc dattraction1.1Piscines1.1Bibliothques1.1Prisons1.1Centres de soins pour toxicomanes1.1Stades sportifs1.1Shopping centers1.1J. Engdahl, J HerltzResuscitation 2005; 65: 171-5

Lieu avec moins de un OCHA / 5ansPar 5 ans

GP Office0.22Golf0.21Petro station0.05Transports publiques0.02Banques0.02Htel0.01Restaurants0.008voitures0.0002J. Engdahl, J HerltzResuscitation 2005; 65: 171-5

Home AED TrialPas encore de rsultats defficacit

ALS: envisagerSquence ABC, VasopresseursAnti arythmiquesCEE per massageHypothermie per resuscitation

Squence ABC,

Cobb LA et al JAMA 1999; 281: 1182-1188

Wik, L et al JAMA 2003; 289: 1389-1395

Adverse effects of interrupting precordial compression during cardiopulmonary resuscitation. Durant procdure AED, lintervalle hands of est une perte de temps?

tude randomise

25 rats mles Sprague Dawle

Induction VF, perdure 4minutes

CEE immdiat ou aprs 10, 20, 30, 40 secondes

Analyse le nombre de RACS et la survie 24 et 48 heuresSato Y et al Crit Care Med 1997; 25: 733-6

Adverse effects of interrupting precordial compression during cardiopulmonary resuscitation. Sato Y et al Crit Care Med 1997; 25: 733-6

Influence of cardiopulmonary resuscitation prior to defibrillation in patients OHCA in VF. Cobb LA et al.JAMA 1999; 281: 1182-1188

Influence of cardiopulmonary resuscitation prior to defibrillation in patients OHCA in VF. RCP-DEA ou DEA-RCP?OHCA en VFComparaison du registre de Seattle1/07/1990 au 31/12/19931/1/1994 au 31/12/199690 sec de RCP avant DEASurvie, tat neurologiqueSous groupe en fx de lintervalle de rponse (< de 4 min, > 4 min)Cobb LA et al.JAMA 1999; 281: 1182-1188

Rsultats Cobb LA et al.JAMA 1999; 281: 1182-1188

Cobb LA et al.JAMA 1999; 281: 1182-1188

Cobb LA et al.JAMA 1999; 281: 1182-1188

Delaying defibrillation to give basic CPR to patients with OH VF: a randomized trial. Etude randomiseOslo, NorvgeOHCA VF3 min RCPDEA versus CPR-DEADlai dinervention < 5min, > 5 minSurvie sortie hpital, 1 an, status neurologiqueWik, L et al JAMA 2003; 289: 1389-1395

Wik, L et al JAMA 2003; 289: 1389-1395

Wik, L et al JAMA 2003; 289: 1389-1395

Wik, L et al JAMA 2003; 289: 1389-1395

Wik, L et al JAMA 2003; 289: 1389-1395

Wik, L et al JAMA 2003; 289: 1389-1395DEA dabordRCP puisDEA

Post Resuscitation CareLe cinquime anneau de la chane de survie

HypothermieCas rapports dAC ayant survcu avec une bonne rcupration neurologique noyadefin 50, dbut 60: Hypo T thrapeutique t plus basse, protocoles diffrents = Survie non amlioreAnnes 90: Reprise dtudes en labo, t moins basses, nouveaux protocoles

Mcanismes daction inconnusDiminution VO2 crbrale

Retard, diminution des mcanismes enzymatiques de destruction

Suppression des ractions avec les radicaux libres O2

Protection de la fluidit des lipoprotines desmembranes cellulaires

Diminution de lacidose intra cellulaire

Inhibition de la synthse, du relargage et de la capture des neurotransmetteurs excitateurs

Guidelines 2000-2005Hypo T lgre (35-32C), modre (32-30C), svre (

Outcome from severe accidental hypotermia in Southern Finland a 10 year reviewT. Silfvast, V PettilResuscitation 2003; 55: 285-290 Rtrospective 1991-2000 Un hpital

Immersion 48 % Environnement froid 39% Submersion 19%

ge 50 ans 83 % homme t24.4 (22.4-26.8) C

Outcome from severe accidental hypotermia in Southern Finland a 10 year reviewGroupe arrt cardiaque ranim

70 min RCP avant instauration bypass cardiaque61% de survivants (14/25)

Facteurs prdictifs de surviege: 41 (32-53) versus 58 ans (55-68) (p

Outcome from sever accidental hypotermia in Southern Finland a 10 year reviewT. Silfvast, V PettilResuscitation 2003; 55: 285-290

Mild therapeutic hypothermia to improve the neurological outcome after cardiac arrestHypotermie post RACS InconscientFV / TV-SP (275 ligibles sur 3551 = 8%) et critres inclusion ++105 minutes post RACS pour commencer le refroidissementMidazolam, Fentanyl, Pancuronium)The Hypothermia after Cardiac Arrest study group NEJM 2002; 346: 549-56

The Hypothermia after Cardiac Arrest study group NEJM 2002; 346: 549-56Mild therapeutic hypothermia to improve the neurological outcome after cardiac arrest

The Hypothermia after Cardiac Arrest study group NEJM 2002; 346: 549-56Mild therapeutic hypothermia to improve the neurological outcome after cardiac arrest

The Hypothermia a fter Cardiac Arrest study group NEJM 2002; 346: 549-56Mild therapeutic hypothermia to improve the neurological outcome after cardiac arrest

Mild therapeutic hypothermia to improve the neurological outcome after cardiac arrestThe Hypothermia after Cardiac Arrest study group NEJM 2002; 346: 549-56

Australie Melbourne9/1996 - 6/1999N = 77 43 hypo t, 34 normo t32C, 12 heuresHypothermie post RACS InconscientFV / TV-SP Midazolam, Vencuronium

SA Bernard et al. NEJM 2002; 346: 557-563Treatment of comatose survivors of OHCA with induced hypotermia

Clinical Characteristics of the 77 Patients with Anoxic Brain Injury Who Were Eligible for RandomizationSA Bernard et al. NEJM 2002; 346: 557-563

Bernard, S. A. et al. N Engl J Med 2002;346:557-563Physiological and Hemodynamic Values

Biochemical Values

Hematologic Values

Bernard, S. A. et al. N Engl J Med 2002;346:557-563Outcome of Patients at Discharge from the Hospital

Induced hypothermia is underused after resuscitation from cardiac arrest: a current practice survey2000 invitations participer600 adresses incorrectes265 rponses 19% de taux de rponseUrgences 41%Soins intensifs 13%Cardiologue 24%Autres 22%BJ Abella, .. L BeckerResuscitation 2005; 64: 181-186

Induced hypothermia is underused after resuscitation from cardiac arrest: a current practice surveyBJ Abella, .. L BeckerResuscitation 2005; 64: 181-186

Hypothermie Questions?Valeur dans lAESP et lasystolie?Quid de lhypothermie per resuscitation?

Is hospital care of major importance for outcome after OHC? A 16-year experience period in the municipality of Goteborg. EMS unique, PEG prhospitalire identique

Hospitalisation OHCA avec RACS 2 hp. Municipaux

1/10/1980 au 31/12/1996 J. Engdahl et al. (Herlitz J) Resuscitation 2000; 43: 201-211

Is hospital care of major importance for outcome after OHC? A 16-year experience period in the municipality of Goteborg. J. Engdahl et al. (Herlitz J) Resuscitation 2000; 43: 201-211

Comment expliquer cette diffrenceLes soins post resuscitation sont diffrentsJ. Engdahl et al. (Herlitz J) Resuscitation 2000; 43: 201-211

In-hospital factors associated with improved outcome after OHCA arrest.A comparison between four regions in Norway. Registre OHCA de 4 rgions en Norvge

Priode dtude: 1995-1999

Recherche de facteurs associs la survie

(prhospitaliers et hospitaliers)

Analyse multivarie A Langhelle et al. (Steen PA) Resuscitation 2003; 56: 247-263

In-hospital factors associated with improved outcome after OHCA arrest.A comparison between four regions in Norway. A Langhelle et al. (Steen PA) Resuscitation 2003; 56: 247-263

Facteurs associs une amlioration de la survie. PREHOSPITALIER

ge < 71 ansAppel RCP < 1 minPas dusage dadrnalineHOSPITALIER

Pas dpilepsie p -3.5 mmol/l p

A multiple logistic regression analysis of in-hospital factors related to survival at six months in patients resuscitated from out-of-hospital VF Finlande Helsinki3 hpitauxSeulement les OCHA en VFEt pas celles dont le RACS < 5 min98 dossiers sur 102 analysablesEtude de la survie 6 mois en fonction de paramtres relevs chaque 4 h, les 72 res heuresCliniques et biologiques (TAS,TAD, Glycmie, Na, K, PaO2, PaCO2,t)Traitements (Vasopresseurs, AB, bloquants, anticoagulants, antiarythmiques, surlvation de la tte)Examens techniques et traitements mcaniques (Coronarographie, PTCA, CABG, cho cur, AICD)

MB Skrifvars et al. Resuscitation 2000; 43: 201-211

Rsultats MB Skrifvars et al. Resuscitation 2000; 43: 201-211Glycmie 8.0mmol/L = 144 mg%

Rsultats MB Skrifvars et al. Resuscitation 2000; 43: 201-211

Rsultats MB Skrifvars et al. Resuscitation 2000; 43: 201-211Mtoprolol: 50 mg, 2x/j ou bisoprolol 2.5 mg, 2x/j

Synthse Post Resuscitation Care (72 re heures)Continuer lALS si larrt se rpte

Techniquer autant quil le faut (Coronarographie, PTCA, Echo cur, EEP, AICD si indiqu)

Veiller assurer une bonne hmodynamique (TA, RC)

Attention la t: hypothermie 24 re h, sinon t < 37.8 C

Maintenir le K< 4 mmol/l et la glycmie < 144-190 mg%

Utiliser ds que possible des bloquants

Empcher la survenue de crises dpilepsie

Table 1. Clinical Characteristics of the 77 Patients with Anoxic Brain Injury Who Were Eligible for Randomization.Table 2. Physiological and Hemodynamic Values.Table 3. Biochemical Values.Table 4. Hematologic Values.Table 5. Outcome of Patients at Discharge from the Hospital.