Post Cardiac Arrest Care Flashcards
Studies have shown that most deaths occur in the first 24 hours after cardiac arrest.
Post Cardiac Arrest Care Step 1
ROSC Obtained
Post Cardiac Arrest Care Step 2
-Manage the airway—ETT quantitative waveform capnography & ETCO2
-Manage respiratory parameters—10 breaths/min (1 every 6 seconds), maintain SpO2 92-98% & PaCO2 35-45
-Manage hemodynamic parameters—Administer Crystalloid and/or vasopressin or inotrope for goal systolic blood pressure of >90 mm Hg
Post Cardiac Arrest Care Step 3
-Obtain 12 lead EKG
Post Cardiac Arrest Care Step 4
Consider emergent cardiac intervention if:
-STEMI is present
-The pt has unstable cardiogenic shock
-Mechanical circulatory support is required
Post Cardiac Arrest Care Step 5
Does the pt follow commands? If “Yes” skip to Step 7
Post Cardiac Arrest Care Step 5
Is the pt comatose?
If “No” proceed to Step 6
Post Cardiac Arrest Care Step 6
-TTM if the pt is not following commands. Start TTM ASAP beginning at 32-36 C for 24 hours using a cooling device w/ feedback loop.
-Obtain brain CT
-Perform EEG monitoring
-Provide other critical care management such as continuously monitoring core temp, maintaining normoxia, normocapnia & euglycemia; providing continuous & intermittent EEG monitoring & lung protective ventilation
Post Cardiac Arrest Care Step 7
Awake?
-Consider other critical care management
*Evaluate and treat rapidly reversible etiologies & involve expert consultation for continued management. Consider H’s & T’s.
Cardiac Rhythms for Post Cardiac Arrest Care:
-Rate—too fast or too slow
-Width of QRS complexes—wide vs narrow
Drugs for Post Cardiac Arrest Care:
-NS or LR 1-2 liters IV bolus for hypotension
-Epinephrine
-Dopamine
-Norepinephrine infusions
PCAC has significant potential to reduce early mortality caused by hemodynamic instability as well as later morbidity caused by Multi-Organ Failure & Brain Injury. PCAC after ROSC can improve the likelihood of pt survival w/ good quality of life.
Merely restoring B/P & gas exchange does not ensure survival & functional recovery. Significant cardiovascular dysfunction can develop after ROSC. These dysfunctions can require active support of blood flow & ventilation including:
-Intravascular volume expansion
-Vasoactive and Inotropic Drugs
-Invasive Devices
Intravascular volume expansion
In addition, TTM & treating the underlying cause of cardiac arrest can impact survival & neurologic outcomes & hemodynamic optimization protocols also serve as part of a bundle of care to improve survival.
