The "SOOTEST-ICU" bundle for optimizing cerebral hypoxia and reperfusion to minimize brain injury after resuscitation from cardiac arrest.

Abstract

Background: Post-cardiac arrest brain injury remains the leading cause of mortality and long-term disability in patients following cardiac arrest (CA). However, optimizing clinical management strategies for bundled therapy after CA still faces challenges.

Methods: For this literature review, we searched PubMed, Web of Science, and SpringerLink databases for high-quality studies published between December 1982 and July 1, 2024. The search included randomized clinical trials, meta-analyses, systematic reviews, and observational studies. References in included studies were also checked to identify additional sources.

Results: Many studies have identified potential targets for interventions to mitigate brain injury and improve outcomes for post-resuscitated patients. To optimize clinical management strategies to minimize brain injury after CA, we developed the acronym "SOOTEST-ICU" bundle, which includes "SOOTEST" therapy to optimize peripheral oxygen delivery and "ICU" intervention to optimize the cerebral oxygen cascade. The order of the "SOOTEST" treatment was organized based on the severity and importance of brain oxygen affecting brain injury. It includes systolic blood pressure and mean arterial pressure management, oxygenation and ventilation management, original etiological treatment, temperature control, electrolytes and acid basic status, seizure control, and targeted substrate delivery. The acronym "ICU" intervention includes intracerebral oxygen delivery, cerebral oxygen diffusion, and oxygen utilization.

Conclusion: The "SOOTEST-ICU" therapy is developed to optimize oxygen and substrate cascades to minimize brain injury after CA.