Goal-directed hemodynamic optimization in the post-cardiac arrest syndrome: a systematic review

Alan E Jones, Nathan I Shapiro, J Hope Kilgannon, Stephen Trzeciak
Resuscitation 2008, 77 (1): 26-9

AIMS: The treatment recommendations from the 2005 International Consensus Conference on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science (hosted by the American Heart Association) advocate a goal-directed treatment strategy for hemodynamic optimization after return of spontaneous circulation (ROSC) in post-cardiac arrest care. We performed a systematic review to (1) examine the available evidence for goal-directed hemodynamic support in the post-cardiac arrest syndrome, (2) determine the effect of such a treatment strategy on survival, and (3) define the specific hemodynamic goals, if any, that have been tested in clinical trials of post-cardiac arrest patients.

METHODS: We conducted a systematic review of the Cochrane Library, MEDLINE, CINAHL, conference proceedings, clinical practice guidelines, and other sources using a comprehensive strategy to identify randomized controlled trials and quasi-experimental studies of goal-directed hemodynamic optimization in patients with ROSC after cardiac arrest.

RESULTS: The comprehensive search yielded a total of 1184 potential publications and after a relevance screen, five studies were eligible for full article review. None of the studies were eligible for inclusion in the final analysis.

CONCLUSIONS: To date, no clinical trials have examined hemodynamic optimization in post-cardiac arrest patients. Although clinical acumen may support the concept that hemodynamic derangements after ROSC should be normalized, there is currently no evidence available to indicate the best strategy for goal-directed hemodynamic support. The current study indicates the need for future clinical investigations designed to determine both the efficacy of hemodynamic optimization in post-cardiac arrest patients and the best endpoints to target as part of a goal-directed strategy.

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