In the ICU

Many people who experience a cardiac arrest will end up in the ICU – Intensive Care Unit. They are a specialist hospital ward that provides treatment and monitoring for people who are very ill. They are also called critical care units (CCU) or intensive therapy units (ITUs).

Patients in an ICU will be looked after closely by a team of ICU staff and will be connected to equipment by a number of tubes, wires and cables, with usually 1 nurse for every 1 or 2 patients.

An ICU can often be an overwhelming place, both for the patient and their loved ones and so we have put together some resources to help ease any anxieties.

Early Stages

During a cardiac arrest, there is no blood flowing through the body; if not treated quickly this can cause widespread injury to organs with the brain being at most risk.

People who have been resuscitated from a cardiac arrest will therefore usually be placed in a medically induced coma to minimise injury to the brain and at this time will also have their breathing supported with a ventilator.

Although this is very important to maximise the chances of recovery, it also means that in the first 72 hours it is often too soon to tell the extent of any brain injury and consequently it is difficult to know whether your loved one will survive or not.

During the initial days after the event, you may see several tests being carried out which will help the medical team understand the presence and extent of any brain injury. This can include a physical examination where they will assess the reflexes in the limbs and the size and response of the pupils, regular blood tests, and imaging of the brain with a computed tomography (CT) scan or magnetic resonance imaging (MRI). In some patients where the results are inconclusive, this initial stage can last up to and over a week.

Recovery

Cardiac arrest and intensive care unit (ICU) admission both cause significant physical and psychological stress. It is common for patients to become disoriented whilst being treated in the ICU and this can lead to patients becoming agitated and aggressive. This is referred to as ‘delirium’ and will normally pass with time. The presence of loved ones can help to reorientate patients experiencing delirium.

Repetitiveness and confusion can be common and quite disturbing in the early stages but they tend to resolve quickly. If these symptoms are being experienced by your loved one then the clinical team should be informed. If they occur regularly then there may be ways in which these symptoms can be supported although it is not always possible to stop them entirely.

Some of the other symptoms experienced in this phase may result from the physical and psychological trauma of the ICU admission. When patients have a breathing tube placed they may sustain some injuries to their throat. This can lead to having difficulty with speaking and swallowing after they have been woken up from their medically induced coma. This is usually temporary but if this is not the case you may want to check if the hospital uses any tools such as RITA or myICUvoice which can help patients with communication. Once a patient is medically stable and is being cared for on a normal hospital ward.

Predicting outcomes

Prognosis or prediction of how patients do in the aftermath of a cardiac arrest can be a very challenging task. Through the Chain of Survival more and more are surviving a cardiac arrest but is not an exact science. There are many factors that can affect the outcome and many of these are often unknown i.e. how soon did the patient receive CPR, the quality of CPR.

Our podcast Life After Cardiac Arrest Episode #48 features an interview with consultant neurologist Professor Tobias Cronberg from Lund University in Sweden on predicting how patients will do after they have had a cardiac arrest. In this episode, we focus on the prognostication aspect and Professor Cronberg gives us some insights into the tools and techniques that are used and the whys and hows of decisions that are made when reasoning on the possible outcomes.

#048 Predicting patient outcomes with Professor Tobias Cronberg Life After Cardiac Arrest

Paul talks with consultant neurologist Professor Tobias Cronberg from Lund University in Sweden on predicting how patients will do after they have had a cardiac arrest.If you listened to episode #044 you will know that Professor Cronberg has a deep interest in brain injury after a cardiac arrest and recently The Lancet published a major review he led into the current state of this subject from prognostication through to rehabilitation.This episode focuses on the prognostication aspect and Professor Cronberg gives us some insights into the tools and techniques that are used and the whys and hows of decisions that are made when reasoning on the possible outcomes.Please be warned that this may be a difficult episode for some to listen to as the professor talks about the stark realities of surviving a cardiac arrest even if you get to the hospital alive.If you enjoyed this podcast please do leave a positive review on Apple or other podcast providers as it helps us to spread the word.Presented and edited by Paul Swindell.Recorded June 2020.  See acast.com/privacy for privacy and opt-out information.

Clinical predictive models of SCA – Survey and analysis

Miracle2 – Risk score for early prediction – study

Miracle2 – Risk score for early prediction – review

Measuring Outcomes

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Photo by Pixabay on Pexels.com

Making it to the hospital/ITU is an important step for someone who experiences a cardiac arrest but unfortunately not everyone will get to be discharged with a good outcome.

Patient outcomes are often measured using a number of scales that give an indication of the patients neurological and physical state. Currently there is no measurement that is specific to cardiac arrest and so the following tools are often used but the Cerebral Performance Category is often used.

The CPC is quite a course scale and ranges from 1-5, with 1 being considered a good outcome and 5 deceased. Most cardiac arrest survivors who are discharged to home would be categorised as a 1 or 2 which is a good neurological recovery although may have minor psychological or neurologic deficits (mild dysphasia, non-incapacitating hemiparesis, or minor cranial nerve abnormalities).

Cerebral Performance Category

Glasgow Coma scale

Modified Rankin scale

Visiting

Visting someone in hospital and especially the ICU can be a stressful experience. We have collated a number of videoas that have been put together to reduce that stress. Additionally, if you are a survivor you may be interested to understand a little more about where you were cared for and by whom.

Virtual ICU Tour
Your visit
Specialist Doctors

NHS Intensive Care – Overview

What to expect when your loved one is in the ICU – Media article

More Help

The primary charity for UK patients is ICU Steps, they have plenty of resources on their website and also have support groups dotted around the country.

Home - ICUsteps
Critical Care Recovery

ICUunwrapped – Leeds Teaching Hospitals NHS

On the road to recovery

The East Suffolk and North Essex NHS Foundation Trust have produced this excellent video covering the sort of critical care patients receive on the road to recovery.

Further Reading

Unexpected recoveries from long-term coma after cardiac arrest