Reanimación Cardio Pulmonar en el área de Terapia Intensiva.

CRITICAL CARE & EMERGENGY MEDICINE VOL. 5

Cardiopulmonary Resuscitation in the Intensive Care Unit

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www.doi.org/10.58281/ccem060126-rev-nar-02

Fernando Rodriguez Solana 1 , Eder Iván Zamarrón López 2 .

1 Terapia intensiva. Centro Médico de Occidente. Terapia intensiva de Ginecología y Obstetricia.
2 Terapia intensiva. Hospital General Regional 6. IMSS Ciudad Madero.

Editor
Manuel Alberto Guerrero Gutierrez , Diego Escarraman Martinez .

Chair
Jorge M Antolinez-Motta .

Abstract

Abstract: Cardiac arrest is a critical medical emergency whose management has evolved in parallel with scientific evidence and international guidelines issued by organizations such as the American Heart Association and the International Liaison Committee on Resuscitation. This article reviews the management of cardiac arrest in the intensive care unit, focusing on the initial assessment, life support interventions, and specific considerations unique to this setting. These include continuous monitoring, cardiopulmonary resuscitation in the prone position, the use of mechanical chest compression devices, and the pivotal role of capnography. The importance of an organized and rapid response is emphasized, with early defibrillation and prompt identification of reversible causes using ultrasonography and other diagnostic tools as key priorities. Special considerations related to patients receiving mechanical ventilation, airway management, and the impact of pharmacotherapy are also discussed. Finally, adaptations required in special scenarios, such as patients supported with extracorporeal membrane oxygenation or those in the postoperative period following thoracic surgery—are highlighted.
Proper implementation of these strategies may improve rates of return of spontaneous circulation and survival among patients experiencing cardiac arrest in the intensive care unit. Cardiac arrest is a quintessential medical emergency; therefore, well-established global guidelines exist, including those from the American Heart Association and the International Liaison Committee on Resuscitation. Over time, and with the accumulation of scientific evidence, protocols for basic and advanced life support have evolved, with some of the most significant changes occurring during the COVID-19 pandemic. Accordingly, this review focuses specifically on the intensive care unit as the clinical setting of interest.

Resumen:  La parada cardiorrespiratoria es una emergencia médica crítica cuya atención ha evolucionado según evidencia científica y
guías internacionales de instituciones como la American Heart Association y el International Liaison Committee on Resuscitation.
Este artículo revisa la atención en la unidad de terapia intensiva, enfocándose en la evaluación inicial, las maniobras de soporte vital, y las particularidades del manejo en este escenario,
incluyendo la monitorización continua, la reanimación en posición prono, el uso de dispositivos mecánicos, y la importancia de la capnografía. Se destaca la relevancia de una
actuación organizada y rápida, priorizando la desfibrilación precoz y la identificación de causas mediante ultrasonografía y otras herramientas. También se abordan consideraciones específicas
para pacientes con ventilación mecánica, manejo
de vías aéreas, y el impacto de la pharmacoterapia. Finalmente, se resaltan las adaptaciones en escenarios especiales como pacientes con oxigenación por membrana extracorpórea o en postquirúrgico torácico. La correcta ejecución de estas estrategias puede mejorar las tasas de recuperación y supervivencia en pacientes en paro cardiorespiratorio en la unidad de terapia intensiva. El paro cardiorespiratorio es una emergencia médica por excelencia y por ello se cuentan con guías establecidas a nivel mundial como lo son la American Heart Association (AHA)¹ y la International Liaison Committee
on Resuscitation (ILCOR) y conforme el paso del tiempo y la evidencia científica han evolucionado los protocolos de atención de soporte vital básico y avanzado, siendo los mas grandes cambios los acontecidos por la pandemia de COVID-19.
Por lo que nos centraremos el escenario a la unidad de terapia intensiva.

Cardiac arrest, cardiopulmonary resuscitation, advanced life support, early defibrillation, extracorporeal membrane oxygenation

Fernando Rodriguez Solana.
Terapia intensiva. Centro Médico de Occidente. Terapia intensiva de Ginecología y Obstetricia.

Eder Iván Zamarrón López.
Terapia intensiva. Hospital General Regional 6. IMSS Ciudad Madero.

  1. **American Heart Association (AHA).**

   Aspectos destacados de las Guías de la American Heart Association 2020 para reanimación cardiopulmonar y atención cardiovascular de emergencia (RCP y ACE). Dallas, Texas: American Heart Association; 2020. Disponible en: [https://cpr.heart.org/-/media/cpr-files/cpr-guidelines-files/highlights/hghlghts_2020eccguidelines_spanish.pdf](https://cpr.heart.org/-/media/cpr-files/cpr-guidelines-files/highlights/hghlghts_2020eccguidelines_spanish.pdf)

  1. **Goyal A, Singh B, Patel PH.**

   Cardiopulmonary resuscitation. En: *StatPearls* [Internet]. Treasure Island (FL): StatPearls Publishing; 2025.

  1. **Berg KM, Bray JE, Ng KC, et al.**

   International consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations (2023): summary of basic, advanced, pediatric and neonatal life support, education, implementation, teams and first aid. 2024.

  1. **Hsu CH, Considine J, Pawar RD, et al.**

   Cardiopulmonary resuscitation and defibrillation for cardiac arrest in the prone position: systematic review. 2021.

  1. **Wong A, Vignon P, Robba C.**

   Use of ultrasound during cardiac arrest. 2023.

  1. **Sahu AK, Timilsina G, Mathew R, Jamshed N, Aggarwal P.**

   “Six-dial strategy”: mechanical ventilation during cardiopulmonary resuscitation. 2020.

  1. **Pinsky MR.**

   Cardiopulmonary interactions: effects of negative and positive pleural pressure changes on cardiac output. En: Dantzer DR (editor). *Cardiopulmonary Critical Care*. 2.ª edición. Philadelphia: W. B. Saunders; 1991.

  1. **Wenzel V, Keller C, Idris AH, et al.**

   Effects of smaller tidal volumes during basic life support ventilation in patients with respiratory arrest. 1999.

  1. **Luo JY, Wang XY, Cai TB, Jiang WF.**

   Setting of ventilator tidal volume and airway pressure alarms during continuous chest compressions in cardiopulmonary resuscitation. 2013.

  1. **White LA, Conrad SA, Alexander JS.**

    Pathophysiology and prevention of manual ventilation–induced lung injury. 2024.

  1. **Sassoon CS, Gruer SE.**

    Characteristics of ventilator pressure and flow trigger variables. 1995.

  1. **Kim JW, Lee JW, Ryu S, et al.**

    Changes in peak inspiratory flow rate and airway pressure according to endotracheal tube size during chest compression. 2020.

  1. **Kolar M, Krizmaric M, Klemen P, Grmec S.**

    End-tidal carbon dioxide as a predictor of successful cardiopulmonary resuscitation in the prehospital setting. 2008.

  1. **Caro-Alonso PA, Rodríguez-Martín B.**

    End-tidal carbon dioxide as an early prognostic marker of return of spontaneous circulation in out-of-hospital cardiac arrest: systematic review. 2021.

  1. **Moitra VK, Einav S, Thies KC, et al.**

    Cardiac arrest in the operating room: resuscitation and management for the anesthesiologist (Part 1). 2018.

  1. **Mishra PR, Aggarwal P, Nayer J, Ekka M, Bhoi S.**

    Ultrasound-guided cardiopulmonary resuscitation: early correction of reversible causes. 2017.

  1. **Perera P, Mailhot T, Riley D, Mandavia D.**

    RUSH examination: rapid ultrasound in shock for the evaluation of critically ill patients. 2010.

  1. **Lichtenstein D.**

    FALLS protocol: lung ultrasound in the hemodynamic assessment of shock. 2013.

  1. **Panchal AR, Berg KM, Hirsch KG, et al.**

    Focused update of advanced cardiovascular life support: advanced airways, vasopressors and extracorporeal cardiopulmonary resuscitation. 2019.

  1. **Kette F, Ghuman J, Parr M.**

    Calcium administration during cardiac arrest: systematic review. 2013.

  1. **Ahn S, Kim YJ, Sohn CH, et al.**

    Sodium bicarbonate in severe metabolic acidosis during prolonged cardiopulmonary resuscitation: randomized controlled pilot study. 2018.

  1. **Shin TG, Choi JH, Jo IJ, et al.**

    Extracorporeal cardiopulmonary resuscitation versus conventional cardiopulmonary resuscitation in in-hospital cardiac arrest. 2011.

[1] Fernando Rodriguez Solana and Eder Iván Zamarrón López. 2026. Reanimación cardio pulmonar en el área de terapia intensiva. CRITICAL CARE & EMERGENGY MEDICINE 5, (January 2026), 87–92. https://doi.org/10.58281/ccem060126-rev-nar-02
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Licencia

© 2025 Critical Care & Emergency Medicine by Ediciones Prado. This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0) .

Licencia Creative Commons CC BY 4.0

The copyrights of the articles published in Critical Care & Emergency Medicine belong to Ediciones Prado. The contents of the articles that appear in the Journal are exclusively the responsibility of the authors and do not necessarily reflect the opinions of the Editorial Committee of the Journal. It is allowed to reproduce the material published in Critical Care & Emergency Medicine without prior authorization for non-commercial use.

ISSN

2992-6785

eISSN: 2992-6785
DOI: 10.3989/ccem

Indexación

Patrocinadores

www.doi.org/10.58281/ccem060126-rev-nar-02

Fernando Rodriguez Solana 1 , Eder Iván Zamarrón López 2 .

1 Terapia intensiva. Centro Médico de Occidente. Terapia intensiva de Ginecología y Obstetricia.
2 Terapia intensiva. Hospital General Regional 6. IMSS Ciudad Madero.

Editor
Manuel Alberto Guerrero Gutierrez , Diego Escarraman Martinez .

Chair
Jorge M Antolinez-Motta .

Abstract

Abstract: Cardiac arrest is a critical medical emergency whose management has evolved in parallel with scientific evidence and international
guidelines issued by organizations such as the
American Heart Association and the International Liaison Committee on Resuscitation. This article reviews the management of cardiac arrest in the intensive care unit, focusing on the initial assessment, life support interventions, and specific considerations unique to this setting. These include continuous monitoring, cardiopulmonary resuscitation in the prone position, the use of mechanical chest compression devices, and the pivotal role of capnography. The importance of an organized and rapid response is emphasized, with early
defibrillation and prompt identification of reversible causes using ultrasonography and other diagnostic tools as key priorities. Special considerations related to patients receiving
mechanical ventilation, airway management, and the impact of pharmacotherapy are also discussed. Finally, adaptations required in special scenarios, such as patients supported with extracorporeal membrane oxygenation or those in the postoperative period following thoracic surgery—are highlighted.
Proper implementation of these strategies may improve rates of return of spontaneous circulation and survival among patients experiencing cardiac arrest in the intensive care unit. Cardiac arrest is a quintessential medical emergency; therefore, well-established global guidelines exist, including
those from the American Heart Association and the International Liaison Committee on Resuscitation. Over time, and with the accumulation of scientific evidence, protocols for basic and advanced life support have evolved, with some of the most significant changes occurring during the COVID-19 pandemic. Accordingly, this review focuses specifically on
the intensive care unit as the clinical setting of interest.

Resumen:  La parada cardiorrespiratoria es una emergencia médica crítica cuya atención ha evolucionado según evidencia científica y
guías internacionales de instituciones como la American Heart Association y el International Liaison Committee on Resuscitation.
Este artículo revisa la atención en la unidad de terapia intensiva, enfocándose en la evaluación inicial, las maniobras de soporte vital, y las particularidades del manejo en este escenario,
incluyendo la monitorización continua, la reanimación en posición prono, el uso de dispositivos mecánicos, y la importancia de la capnografía. Se destaca la relevancia de una
actuación organizada y rápida, priorizando la desfibrilación precoz y la identificación de causas mediante ultrasonografía y otras herramientas. También se abordan consideraciones específicas
para pacientes con ventilación mecánica, manejo
de vías aéreas, y el impacto de la pharmacoterapia. Finalmente, se resaltan las adaptaciones en escenarios especiales como pacientes con oxigenación por membrana extracorpórea o en postquirúrgico torácico. La correcta ejecución de estas estrategias puede mejorar las tasas de recuperación y supervivencia en pacientes en paro cardiorespiratorio en la unidad de terapia intensiva. El paro cardiorespiratorio es una emergencia médica por excelencia y por ello se cuentan con guías establecidas a nivel mundial como lo son la American Heart Association (AHA)¹ y la International Liaison Committee
on Resuscitation (ILCOR) y conforme el paso del tiempo y la evidencia científica han evolucionado los protocolos de atención de soporte vital básico y avanzado, siendo los mas grandes cambios los acontecidos por la pandemia de COVID-19.
Por lo que nos centraremos el escenario a la unidad de terapia intensiva.

Cardiac arrest, cardiopulmonary resuscitation, advanced life support, early defibrillation, extracorporeal membrane oxygenation

Fernando Rodriguez Solana.
Terapia intensiva. Centro Médico de Occidente. Terapia intensiva de Ginecología y Obstetricia.

Eder Iván Zamarrón López.
Terapia intensiva. Hospital General Regional 6. IMSS Ciudad Madero.

  1. **American Heart Association (AHA).**

   Aspectos destacados de las Guías de la American Heart Association 2020 para reanimación cardiopulmonar y atención cardiovascular de emergencia (RCP y ACE). Dallas, Texas: American Heart Association; 2020. Disponible en: [https://cpr.heart.org/-/media/cpr-files/cpr-guidelines-files/highlights/hghlghts_2020eccguidelines_spanish.pdf](https://cpr.heart.org/-/media/cpr-files/cpr-guidelines-files/highlights/hghlghts_2020eccguidelines_spanish.pdf)

  1. **Goyal A, Singh B, Patel PH.**

   Cardiopulmonary resuscitation. En: *StatPearls* [Internet]. Treasure Island (FL): StatPearls Publishing; 2025.

  1. **Berg KM, Bray JE, Ng KC, et al.**

   International consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations (2023): summary of basic, advanced, pediatric and neonatal life support, education, implementation, teams and first aid. 2024.

  1. **Hsu CH, Considine J, Pawar RD, et al.**

   Cardiopulmonary resuscitation and defibrillation for cardiac arrest in the prone position: systematic review. 2021.

  1. **Wong A, Vignon P, Robba C.**

   Use of ultrasound during cardiac arrest. 2023.

  1. **Sahu AK, Timilsina G, Mathew R, Jamshed N, Aggarwal P.**

   “Six-dial strategy”: mechanical ventilation during cardiopulmonary resuscitation. 2020.

  1. **Pinsky MR.**

   Cardiopulmonary interactions: effects of negative and positive pleural pressure changes on cardiac output. En: Dantzer DR (editor). *Cardiopulmonary Critical Care*. 2.ª edición. Philadelphia: W. B. Saunders; 1991.

  1. **Wenzel V, Keller C, Idris AH, et al.**

   Effects of smaller tidal volumes during basic life support ventilation in patients with respiratory arrest. 1999.

  1. **Luo JY, Wang XY, Cai TB, Jiang WF.**

   Setting of ventilator tidal volume and airway pressure alarms during continuous chest compressions in cardiopulmonary resuscitation. 2013.

  1. **White LA, Conrad SA, Alexander JS.**

    Pathophysiology and prevention of manual ventilation–induced lung injury. 2024.

  1. **Sassoon CS, Gruer SE.**

    Characteristics of ventilator pressure and flow trigger variables. 1995.

  1. **Kim JW, Lee JW, Ryu S, et al.**

    Changes in peak inspiratory flow rate and airway pressure according to endotracheal tube size during chest compression. 2020.

  1. **Kolar M, Krizmaric M, Klemen P, Grmec S.**

    End-tidal carbon dioxide as a predictor of successful cardiopulmonary resuscitation in the prehospital setting. 2008.

  1. **Caro-Alonso PA, Rodríguez-Martín B.**

    End-tidal carbon dioxide as an early prognostic marker of return of spontaneous circulation in out-of-hospital cardiac arrest: systematic review. 2021.

  1. **Moitra VK, Einav S, Thies KC, et al.**

    Cardiac arrest in the operating room: resuscitation and management for the anesthesiologist (Part 1). 2018.

  1. **Mishra PR, Aggarwal P, Nayer J, Ekka M, Bhoi S.**

    Ultrasound-guided cardiopulmonary resuscitation: early correction of reversible causes. 2017.

  1. **Perera P, Mailhot T, Riley D, Mandavia D.**

    RUSH examination: rapid ultrasound in shock for the evaluation of critically ill patients. 2010.

  1. **Lichtenstein D.**

    FALLS protocol: lung ultrasound in the hemodynamic assessment of shock. 2013.

  1. **Panchal AR, Berg KM, Hirsch KG, et al.**

    Focused update of advanced cardiovascular life support: advanced airways, vasopressors and extracorporeal cardiopulmonary resuscitation. 2019.

  1. **Kette F, Ghuman J, Parr M.**

    Calcium administration during cardiac arrest: systematic review. 2013.

  1. **Ahn S, Kim YJ, Sohn CH, et al.**

    Sodium bicarbonate in severe metabolic acidosis during prolonged cardiopulmonary resuscitation: randomized controlled pilot study. 2018.

  1. **Shin TG, Choi JH, Jo IJ, et al.**

    Extracorporeal cardiopulmonary resuscitation versus conventional cardiopulmonary resuscitation in in-hospital cardiac arrest. 2011.

[1] Fernando Rodriguez Solana and Eder Iván Zamarrón López. 2026. Reanimación cardio pulmonar en el área de terapia intensiva. CRITICAL CARE & EMERGENGY MEDICINE 5, (January 2026), 87–92. https://doi.org/10.58281/ccem060126-rev-nar-02
PDF
HTML

Licencia

© 2025 Critical Care & Emergency Medicine by Ediciones Prado. This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0) .

Licencia Creative Commons CC BY 4.0

The copyrights of the articles published in Critical Care & Emergency Medicine belong to Ediciones Prado. The contents of the articles that appear in the Journal are exclusively the responsibility of the authors and do not necessarily reflect the opinions of the Editorial Committee of the Journal. It is allowed to reproduce the material published in Critical Care & Emergency Medicine without prior authorization for non-commercial use.

ISSN

2992-6785

eISSN: 2992-6785
DOI: 10.3989/ccem

Indexación

Patrocinadores

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