Post Cardiac Arrest Administrative Guideline

Question 1

BLS procedures

Answer 1

Support Airway/Oxygenation/Ventilation
Place on high flow O 2 via NRB if no ETI or SGA
Ventilation rate of 8-10 bpm
Do not overventilate/hyperventilate
Prevent hyperthermia only, do not perform therapeutic hypothermia
Prepare for potential rearrest
Keep finger on pulse to detect loss of pulses and monitor EtCO 2

Question 2

ALS procedures

Answer 2

Obtain 12 lead ECG as soon as possible
Treat shock per Shock AG
Consider the following if indicated:
Hypoglycemia/Hyperglycemia AG
Bradycardia AG

Question 3

What happens if they rearrest?

Answer 3

For rearrest en route - resume chest compressions
If PEA, treat shock and continue compressions
Defibrillate for VF/pVT and resume compressions
If still on scene follow OHCA AG and Dead on Scene AG
For PEA rearrest may give second dose of epinephrine (1 mg/10mL) 0.01 mg/kg IV/IO (max dose 1 mg) if was not
given before the patient acchieved ROSC (Max total dose during resuscitation is 2 mg)

Question 4

Rearrest guidelines

Answer 4

• EtCO 2 should remain above 20 - lower readings may indicate re-arrest
• Titrate O 2 to maintain saturation between 94-99%
• Obtain a 12 lead; if STEMI, transmit ECG and expedite preparation for transport
• Treat bradycardia per Bradycardia AG
• Once loaded for transport, reassess airway and pulse
• Assure there are appropriate personnel for transport, particularly in the event of rearrest
• Titrate fluid resuscitation and vasopressor administration to maintain SBP of 90 ? 100 mmHg or Mean
  Arterial Pressure (MAP) of 65 ? 80 mmHg.

Question 5

Should you pace rearrest patients?

Answer 5

• While transcutaneous pacing may otherwise be indicated in the ischemic heart, consider the
  danger of missed re-arrest while pacing.
• In general titrate pressors as needed, and only attempt pacing if indicated in the post ROSC patient if
  mechanical capture can absolutely be verified (i.e. finger on the pulse with good blood pressure) and the
  patient is under constant monitoring.

Question 6

Basics of rearrest care

Answer 6

esume chest compressions and treat underlying rhythm.
- For PEA - treat shock with fluid bolus and resume chest compressions
- If the patient has not already received the max total epinephrine dose (2 doses max), may administer
the additional dose of epinephrine.
- For PEA - VF/pVT defibrillate and resume chest compressions
- Treat other underlying rhythms, such as torsades, per OHCA Administrative Guideline.