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Resuscitation


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Resuscitation is the process of correcting physiological disorders (such as lack of breathing or heartbeat) in an acutely ill patient. It is an important part of intensive care medicine, anesthesiology, trauma surgery and emergency medicine. Well-known examples are cardiopulmonary resuscitation and mouth-to-mouth resuscitation.

Adequate resuscitation and end-organ perfusion is best indicated by urine output of 0.5-1 mL/kg/h. For the average adult male weighing ~70 kg this would mean a urine output of 35 mL/h (70 x 0.5 = 35 mL/h). Heart rate, mental status, and capillary refill may be affected by underlying disease processes and are thus less reliable markers for adequate resuscitation.

For subsequent treatment, resuscitations have to be properly recorded. One example is trauma care. Even though there is a strong expansion of electronic health records, within the healthcare industry, resuscitation documentation is still often handwritten, increasing the risk of incomplete documentation. Novel options like tablet-based solutions help to digitalize this process. For improved documentation quality, future solutions have to be accepted by clinicians and well-integrated into their workflows.

SystemExample causesBiomarkerTreatment
Hypoperfusion (Circulatory shock)Haemorrhagic shockHypovolemia (Hypovolemic shock)Intravascular volume status (Preload)Heart rate (Tachycardia) / Systolic blood pressure (Hypotension) / Decreased urine outputIntravenous fluid / Intraosseous infusion / Blood transfusion with packed red blood cells
Cardiogenic shockCardiac outputPositive inotropic agents / Chronotropes
Distributive shockSepsis (Septic shock)Vascular permeabilityVasopressors
Neurogenic shockTotal peripheral resistance
Obstructive shockCardiac tamponadeBeck's triadPericardiocentesis/Thoracotomy with pericardial window
Tension pneumothoraxThoracentesis/Chest drain
Pulmonary embolismThrombolysis/Embolectomy
Acid–base imbalanceAcidosispHSodium bicarbonate
AlkalosisInterventional/Supportive
Gas exchange (Respiratory failure)HypercapniaPaCO2Interventional/Supportive
HypoxiaPaO2Oxygen therapy
Altered level of consciousnessComaNarcosis (Drug overdose) / Stroke (Intracranial hemorrhage)Glasgow Coma ScaleInterventional/Supportive
Blood sugar regulationHyperglycemiaBlood sugarInsulin
HypoglycemiaGlucose
Electrolyte imbalanceHyperkalemiaSerum potassiumCalcium chloride/Calcium diglutamate, others
HypokalemiaPotassium
CoagulopathyHypocoagulabilityCoagulation screenFresh frozen plasma/Cryoprecipitate/Platelets
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