Post-cardiac Arrest Care: Intensive Care Strategies to Reduce Neurological Injury and Mortality
Year: 2026
Type: book-chapter
Abstract: Post-cardiac arrest syndrome is responsible for substantial morbidity and mortality, with hypoxic-ischemic brain injury representing the main determinant of functional prognosis among survivors. This review aimed to analyze the scientific evidence produced between 2022 and 2026 on intensive care strategies directed at reducing neurological injury and mortality after cardiac arrest, with emphasis on temperature control, hemodynamic and ventilatory targets, early coronary angiography, extracorporeal cardiopulmonary resuscitation, and multimodal neuroprognostication. A narrative literature review was conducted, with a non-systematic search carried out in September 2026, prioritizing guidelines, randomized clinical trials, meta-analyses, cohort studies, and narrative reviews indexed in PubMed/MEDLINE and available on open-access platforms, without prior protocol registration, peer screening, or formal risk-of-bias assessment of the included studies. The evidence indicates that targeted temperature control remains recommended, without demonstrated superiority of lower hypothermia targets over controlled normothermia, while more or less liberal hemodynamic and oxygenation targets did not consistently modify mortality or neurological outcome in large randomized trials. Emergent coronary angiography remains indicated in patients with ST-segment elevation; in its absence, the benefit of early angiography appeared only in observational studies, without confirmation in randomized clinical trials, so its indication in these cases should be selective, reserved for cardiogenic shock, electrical instability, or significant persistent ischemia. Extracorporeal resuscitation may benefit selected patients with refractory arrest, and multimodal neuroprognostication, combining clinical examination, electroencephalography, somatosensory evoked potentials, and serum biomarkers, increases the accuracy of outcome prediction and reduces the risk of premature decisions to withdraw life-sustaining therapy. It is concluded that reducing neurological injury and mortality after cardiac arrest depends on the systematic and individualized application of a bundle of intensive care interventions, rather than on any single isolated measure.
Source: Seven Editora eBooks
Authors: Eberson da Silva Rodrigues do Nascimento, Marco Antônio Franco Cançado, Lucas Gomes Cabral, Vitória Moyses de Arruda, Jennifer Rocha de Castro, Walquiria Simony da Costa Queiroz, Carlos Augusto Pereira Ventura Batista, Isabela Vitória Felberk de Oliveira, Fernanda Kamei, Wesllem Henrique Piedade Mesquita, Tales Geraldo Zordan Ramos, Norgyelte Daurelle Dorcas Nguie Olloatsia, Pedro Henrique Soares Pinheiro Rocha, Juliana Barbosa Niero, Hugo Vianna de Oliveira, João Rafael de Mattos Agostini Silva, Izabella Costa Pirovani Machado, Eduarda Carolina Saggin, Ricardo Marangoni, Ana Hecktheuer Canzi, Marco Antonio Barbieri
Language: English
Subfield: Emergency Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
OpenAlex ID: W7220375002