The utilization of life-saving medication for AMI such as (3-blockade, angiotensin-converting enzyme inhibitors, anticoagulants, and inhibitors of platelet adhesiveness has not been universal in AMI patients outside the ICU setting; however, in the ICU, their utilization is often precluded by dependence on (3-agonists, hypotension, and coagulopathy. Importantly, a too-liberal administration of antiar-rhythmic agents in such patients may be more harmful than beneficial. New approaches to AMI in critically ill patients have not been developed, but the management of cardiogenic shock secondary to myocardial infarction has improved considerably. Source
There have been few systematic studies in human cardiopulmonary resuscitation (CPR); hence, almost all the changes in recommendations over the last 25 years result from low-level evidence. Innovative technology has led to the increased availability and ease of use of defibrillators, which, even when used by untrained bystanders, can improve outcomes from out-of-hospital cardiac arrest due to ventricular fibrillation, the most common reason for cardiac arrest in the community. We have learned that we used excessively frequent ventilatory rates, and that frequent or lengthy interruptions of cardiac compressions can be deleterious. Traditional therapies, for example, the routine use of bicarbonate, have been challenged. Likewise, amioda-rone has replaced lidocaine in the management of life-threatening ventricular arrhythmias, although longterm outcome data are lacking, particularly in out-ofhospital ventricular fibrillation. Vasopressin has been introduced as a potent and reliable vasoconstrictor during CPR, especially in combination with epinephrine and particularly in cases presenting with asystole. Therapeutically induced mild hypothermia for 24 h after resuscitation has also improved neurologic outcomes for some patients.