Post-resuscitation care after cardiac arrest is an important emergency and critical care
issue. The post-arrest care after the return of spontaneous circulation has also been
incorporated into the chain of survival and resuscitation guidelines. After the regain of
spontaneous circulation, cardiac arrest patients will face the challenges of post-arrest
syndrome, which includes post-anoxic brain injury, myocardial dysfunction, systemic
ischemia-reperfusion, and persistent precipitating causes. The hypoxic brain injury will
impair the autoregulation of cerebral blood vessels, thereby affecting the adjustment of
intracranial pressure (ICP) and causing cerebral edema. High-quality post-arrest care
including targeted temperature management, optimization of hemodynamics and respiratory
care, control of blood sugar, monitoring and treatment of epilepsy, etc. The goal is to
achieve neuroprotective effects and improve patient outcomes.
The modalities that currently have more evidence for neurocritical care and
neuroprognosis include electroencephalogram (EEG) monitoring, pupillary light reflex,
brain imaging such as computed tomography (CT) and magnetic resonance imaging (MRI),
somatosensory evoked potentials (SSEP), and serum biomarkers such as neuron-specific
enolase (NSE), etc. Direct ICP monitoring is not routinely used in cardiac arrest
patients due to a lack of clinical experience and concurrent use of antiplatelet
medications or anticoagulants. The application of ICP monitoring in neurocritical care
can be based on the experience of traumatic brain injury. ICP monitoring can facilitate
early detection, determination of treatment strategies, and prediction of outcomes.
Cerebral perfusion pressure (CPP) can also be obtained by ICP monitoring. Current head
injury treatment guidelines recommend maintaining CPP at around 60-70 mmHg. However,
there are no current recommendations for CPP standards for post-arrest patients. In
recent years, there have been studies on the utilization of the pressure reactivity index
to identify the optimized CPP in patients with traumatic brain injury, but not yet
applicated in post-arrest patients.
This study aims to establish the ICP and CPP monitoring process and analyze the result in
post-arrest patients, to validate the correlation between direct and non-invasive ICP
monitoring indicators, to establish a protocol of management of elevated ICP and
insufficient CPP in post-arrest care, to establish a protocol for personalizing CPP and
MAP optimization, and to analyze its impact on neuroprognosis.