New Guidelines Shape Care After Cardiac Arrest
After return of spontaneous circulation, teams are urged to follow the ABCDE approach.
New post-resuscitation guidelines offer practical steps to help critical care teams improve patients’ recovery after cardiac arrests, focusing on immediate stabilization, prevention of secondary injury, and coordinated care during the post-arrest period.
“European Resuscitation Council and European Society of Intensive Care Medicine Guidelines 2025: Post-Resuscitation Care,” in Intensive Care Medicine, provides detailed recommendations for oxygenation and ventilation control, coronary reperfusion, hemodynamic monitoring, seizure management, temperature regulation and prognostication. The guidelines also address long-term outcomes, rehabilitation and organ donation, while pediatric care is described separately in the ERC Paediatric Life Support guidelines.
Several key messages are highlighted in a diagram for bedside use. After return of spontaneous circulation, teams are urged to follow the ABCDE approach, with attention to airway management, oxygen saturation between 94% and 98%, normocapnia and maintaining systolic blood pressure above 100 mm Hg or 60-65 mm Hg mean arterial pressure.
Other points include early coronary angiography when occlusion is suspected, active prevention of fever in comatose patients, and multimodal strategies to predict neurological outcomes. Medical teams should assess physical and non-physical rehabilitation needs before discharge, ensuring patients are referred promptly to the appropriate services.
A related article in PulmCCM reviews management of intermediate high risk pulmonary embolism. Current practice relies on anticoagulation as the standard therapy, but mechanical thrombectomy is being studied as a viable option to rapidly reduce clot burden.
The article reports findings from the STORM PE trial, which compared thrombectomy plus anticoagulation to anticoagulation alone. Patients treated with thrombectomy showed short term improvements in pulmonary pressures, right to left ventricular ratios, heart rate and oxygen requirements.
The article reports findings from the STORM PE trial, which compared thrombectomy plus anticoagulation to anticoagulation alone. Patients treated with thrombectomy showed short term improvements in pulmonary pressures, right to left ventricular ratios, heart rate and oxygen requirements.
These changes indicated effective removal of clot material. However, mortality outcomes remained uncertain, with two deaths occurring in the thrombectomy arm. The article highlights both the physiological improvements and the unresolved survival impact of thrombectomy in this patient group.
Moving Toward Better ICU Mobility Outcomes
A multidisciplinary quality improvement initiative can improve adherence to daily mobility goals.
An ICU mobility initiative significantly boosted adherence to daily goals, with nurses helping patients meet 65.4% of mobility targets compared with 48.6% before the program was introduced.
“Multidisciplinary Approach to Early Mobility at an Academic Medical Center,” in Critical Care Medicine, promotes education, awareness, resources and barrier reduction to help patients reach the mobility goals of proper intensity. From July 2023 to February 2024, the study enrolled 547 patients, split between an intervention ICU (271 patients) and a control ICU (276 patients).
Before the program, mobility goal adherence was nearly identical for both units. “After controlling for demographic, clinical and ICU characteristics,” analyses showed that patients in the intervention ICU were 1.96 times more likely to reach daily mobility goals than the control group, with no significant differences in length of stay or mortality.
RNs and additional medical staff developed and implemented the following:
- Education: RNs and physical therapists collaborated on techniques to mobilize critically ill and intubated patients, dispelling contraindication myths and making educational materials available to team members. They also highlighted the benefits of early mobility with resident education.
- Awareness: Staff members tracked mobility goals twice daily through interdisciplinary huddles and signage on patients’ doors and huddle boards. Emails to physicians and patient/family handouts reinforced practices and awareness.
- Resources: Nurse leaders discussed mobility barriers at monthly ABCDEF bundle sessions, and physical therapists were committed to mobilizing at least two patients with complex needs every day. Unit-based RN champions provided bedside education.
“By focusing on mobility goals at least twice a day with multidisciplinary investment, our intervention was able to bring greater attention to early mobility, identify barriers that would need to be addressed the following day and shift the culture within the ICU,” the study adds.
AACN resources include a CSI project, a blog on delirium and mobility, a webinar on the ABCDEF bundle and a CE article on early mobility.
Guidance Refines TXA Use in Trauma Care
The statement asks EMS systems to implement structured QI programs to track TXA use, monitor for complications and ensure adherence to protocol.
For adult trauma patients with clinical signs of hemorrhagic shock, prehospital tranexamic acid (TXA) may reduce mortality when administered after lifesaving interventions less than three hours post-injury.
“Tranexamic Acid in Trauma: A Joint Position Statement and Resource Document of NAEMSP, ACEP, and ACS COT,” in The Journal of Trauma and Acute Care Surgery, notes that prehospital TXA appears safe, with no demonstrated increase in thromboembolic events or seizures. While the ideal dose rate is undetermined, current evidence suggests that emergency medical service (EMS) agencies use either a 1 g intravenous/intraosseous (IV/IO) dose (followed by a hospital-based 1-g infusion over eight hours) or a 2 g dose as an infusion or slow push.
A team from the National Association of EMS Physicians, the American College of Emergency Physicians, and the American College of Surgeons Committee on Trauma developed the statement after reviewing studies on short term survival, long term outcomes and blood product use. Their analysis found a 40% lower risk of 24 hour mortality with prehospital TXA, smaller absolute reductions of 2.3% and 2% at six and 12 hours, respectively, and no consistent benefit at 28 or 30 days.
“A multidisciplinary team, led by EMS physicians, that includes EMS clinicians, emergency physicians and trauma surgeons, should be responsible for developing a quality improvement program to assess prehospital TXA administration for protocol compliance and identification of clinical complications,” the statement notes.
The statement, which updates the guidance published in 2016, also stresses clear communication of any prehospital TXA administration to the receiving healthcare team to support appropriate monitoring and prevent possible duplicate dosing.
While prehospital TXA appears safe, more studies are needed to “further define the role of TXA for prehospital trauma.” EMS agencies should weigh feasibility, resources, training and trauma system coordination before implementation, the statement adds.
Generative AI Broadens Toolbox for ICU Nurse Instruction
The novice simulation instructors generally found the tool beginner-friendly and a time-saver.
Generative artificial intelligence (Gen AI) can be an effective tool to develop simulation exercises for nurse instruction, but privacy and ethical considerations must be explored.
In “Leveraging Generative Artificial Intelligence to Enhance ICU Novice Simulation Instructors’ Case Design: A Qualitative Study,” in Clinical Simulation in Nursing, educators were interviewed about value, efficiency, enhanced engagement and transformative modeling when working with Gen AI to build training scenarios for new ICU nurses: “Gen AI can rapidly generate logically structured and contextually appropriate simulation cases based on input prompts, significantly reducing the time required for manual case design.”
Based on in-depth interviews with 13 novice simulation instructors at one hospital in China, the study analyzed responses and divided them into three main themes: perceived value and benefits, potential for expansion, and concerns and limitations. The instructors generally found the AI tool beginner-friendly and a time-saver, noting that it helped turn abstract concepts into useful scenarios that broaden their resource libraries.
Additional benefits include the ability to personalize learning scenarios based on experience level, create interactive lessons, and apply Gen AI to areas such as literature summaries and emergency drills. Some of the downsides that need to be addressed include a tendency for instructors to over-rely on technology, the presence of clinical errors that demonstrate a need for careful review, and concerns about privacy and data security if a learning model inadvertently reveals personal patient information.
While acknowledging the limitations of a single-site data pool, the study notes the cost-efficiency and rapid ability of Gen AI to build a variety of scenarios quickly. “This has fundamentally changed how we learn simulation education – shifting from a traditional instructor-led model to a collaborative learning approach with AI, where students explore and learn through AI-driven scenarios,” notes a study participant.
AACN resources include “Navigating Ethical Implications of Artificial Intelligence in Nursing Practice,” an NTI recorded session.
Algorithm Uses Mammograms to Assess Cardiovascular Risk
A deep learning algorithm predicted cardiovascular risk based on routine mammography imaging at a rate comparable to other assessments, offering another potential screening method for women at risk.
“Predicting Cardiovascular Events From Routine Mammograms Using Machine Learning,” in Heart, explains that the algorithm had a concordance index of 0.72 using only imaging and participant age as inputs without additional clinical information: “A deep learning algorithm based on only mammographic features and age predicted cardiovascular risk with performance comparable to traditional cardiovascular risk equations.”
The study used screening data from 49,196 Australian women with an average follow-up period of 8.8 years, and 3,392 of them experienced their first major cardiovascular event (atherosclerotic disease, heart failure, myocardial infarction or stroke) during that time. “A key advantage of the mammography model we developed is that it did not require additional history taking or medical record data and leveraged an existing risk screening process widely used by women.”
The algorithm, using a DeepSurv model and compared against other standard cardiovascular risk tools, demonstrates that existing mammogram data could provide additional risk prediction beyond early cancer diagnosis. The study adds that some mammographic features have been associated with cardiovascular risk, but research has not yet demonstrated a link.
“Breast arterial calcification (BAC) has been shown to correlate with the risk of cardiovascular events and with vascular risk factors such as diabetes, hypertension and hypercholesterolemia,” notes a related article in Cardiovascular Business, which quotes the article in Heart. “However, BAC is not associated with obesity and is inversely associated with smoking, suggesting using BAC alone to predict cardiovascular risk may have limitations.”
Future studies are recommended to determine the benefits, including cost-effectiveness, of mammography-based cardiovascular risk prediction.
Noninvasive vs. Invasive BP Monitoring After Shock
Noninvasive BP monitoring might replace invasive monitoring for most patients with shock.
Noninvasive blood pressure monitoring in patients with shock produced results that were similar to early arterial catheter insertion, indicating that traditional guidelines could be modified.
“Deferring Arterial Catheterization in Critically Ill Patients With Shock,” a randomized trial in The New England Journal of Medicine (NEJM), notes that death rates after 28 days and other secondary measurements were comparable for patients using an automated cuff instead of an inserted catheter line: “These findings suggest that noninvasive blood pressure monitoring can safely and effectively replace invasive monitoring for most patients with shock, thus mitigating the risks associated with the use of an arterial catheter.”
The trial involved nonsurgical ICU patients at nine French hospitals from 2018 to 2022, split between the two methods (504 noninvasive and 502 invasive). Some members (14.7%) of the noninvasive group escalated to receive an arterial catheter.
There were 173 deaths (34.3%) in the noninvasive group and 185 (36.9%) in the invasive group by day 28, and the two groups performed similarly in secondary assessments of severity of organ failure within seven days, dialysis within 28 days or death within 90 days. More patients reported pain in the noninvasive group (13.1%) due to the cuff than in the invasive group (9.0%). Also, 8.2% of the invasive group had hematoma or hemorrhage related to catheterization, but the incidence of blood sampling per 1,000 ICU days was 742 in the noninvasive group compared to 269 in the invasive group (excluding arterial catheter placements).
About 90% of patients received vasopressors, and even those receiving extremely high doses could continue in the noninvasive group per study protocols. Trial limitations included being a nonblinded study with a small number of post-surgical patients or those with a body mass index above 40, so the results may not be generalizable.
“This trial should profoundly affect ICU practice,” author Hayley Gershengorn, Miller School of Medicine, writes in an editorial in NEJM, as quoted in an article in MedPage Today. “Modern-day intensive care can be more humanizing and less invasive than we once presumed.”