[Cardiac resuscitation-associated lung edema (CRALE): evaluation of diagnostic and therapeutic approaches by an expert group of the German Cardiac Society].

Abstract

Sudden cardiac arrest (CA) is one of the leading causes of death in Europe, with over 70,000 cases annually in Germany. This study aims to evaluate diagnostic and therapeutic approaches for pulmonary edema in the post-resuscitation phase among intensive care physicians in Germany. Methods: The Working Group on Cardiopulmonary Resuscitation (AG42) of the German Cardiac Society conducted a web-based survey among its members. The survey assessed diagnostic methods, therapeutic strategies, and risk factors related to pulmonary edema after resuscitation. Results: A total of 77 participants, with a mean age of 43.9 years (±9.6), took part in the survey. Among them, 54.5% had more than 10 years of clinical experience in acute and intensive care medicine. Most clinics have access to radiological and sonographic procedures as well as advanced hemodynamic monitoring. Diagnostic measures are predominantly performed immediately upon admission (49.4%) or within one hour (36.4%) and are typically monitored every eight hours (77.9%). The oxygenation index (paO₂/F_iO₂) is used by 64.9% to assess the severity of pulmonary edema, followed by qualitative evaluation of chest X-rays (46.8%) and B-line scoring via lung ultrasound (33.8%). Therapeutic approaches focus on optimizing ventilation parameters, hemodynamic management, and the use of loop diuretics. To prevent pulmonary edema, participants favor a differentiated therapy involving volume and vasoactive agents, guided by invasive hemodynamic measurements. Conclusion: Pulmonary edema, alongside cardiac and cerebral dysfunctions, represents a significant challenge in managing post-resuscitation syndromes. The survey results reveal substantial variability in diagnostic and therapeutic approaches. Prospective studies are needed to better understand the complex pathological mechanisms and develop standardized protocols.