Emergency Medicine Book

http://www.fpnotebook.com/

Post-Cardiac Arrest Care

Aka: Post-Cardiac Arrest Care, Stabilization following Cardiac Arrest, Post-Resuscitation Care, Post-Cardiac Arrest Syndrome, Stabilization following CPR, Return of Spontaneous Circulation, ROSC
Advertisement
  1. Management
    1. Respiratory
      1. Avoid hyperoxia
        1. Keep Oxygen Saturation 93-97%
        2. Poor outcomes associated with PaO2 >300 mmHg
        3. Kilgannon (2010) JAMA 303(21): 2165-71
      2. Avoid Hyperventilation
        1. Keep Tidal Volumes and ventilation rates low
        2. Hyperventilation increases intrathoracic pressure and decreases venous return and cardiac output
        3. Hyperventilation results in decreased CO2 and cerebral Vasoconstriction
    2. Circulatory
      1. Prevent Hypotension
        1. Keep Mean arterial pressure (MAP) 65-100 (preferably 70-80 or higher)
        2. Start low dose pressor and increase if Blood Pressure begins to fall
        3. Replace fluids to treat hypovolemia
      2. Treat underlying cause
        1. Early Angioplasty (PCI) for EKG signs of ST Elevation Myocardial Infarction (STEMI)
        2. Consider early PCI even if no signs of STEMI on EKG
          1. Coronary events are responsible for 40% of Cardiac Arrests
          2. Any shockable rhythm may predict benefit with early PCI
    3. Neurologic
      1. See Induced Therapeutic Hypothermia
      2. Goal is Return of Neurologic Function (RONF)
  2. References
    1. Mattu and Herbert (2012) EM: RAP 12(4): 5-6
    2. Stub (2011) Circulation 123(13): 1428-­35

Navigation Tree