Post-Resuscitation Care

Question 1

Post-cardiac arrest syndrome

Answer 1

Characterized by:

• Post-CA brain injury
• Post-CA myocardial dysfunction
• Post-CA ischemia/reperfusion injury

Question 2

Therapeutic hypothermia

Answer 2

Improve neurologic outcomes in post-cardiac arrest patients with rapid reduction of core body temperature to 32-34^oC following cardiac arrest

Temperature is maintained here for 24-48 hours following induction.

Question 3

Post-cardiac arrest myocardial dysfunction

Answer 3

Biventricular myocardial dysfunction due to multiple factors that occurs transiently following resuscitation from cardiac arrest

Question 4

Post-cardiac arrest encephalopathy

Answer 4

Ischemic brain injury in which the two main manifestations are:

1. Depressed level of consciousness
2. Seizures

Question 5

Hallmarks of post-resuscitation care

Answer 5

1. Therapeutic hypothermia
2. Early coronary angiography and PCI
3. Hemodynamic support with inotropes/pressors
4. Rapid extubation

Question 6

Target oxygenation level for post-cardiac arrest patients

Answer 6

94-96% O2 sat

Higher levels of O2 saturation and PO2 are associated with higher mortality, presumably due to worse ischemia/reperfusion injury in the immediate post-arrest timeframe

Question 7

What happens if you rewarm a patient from therapeutic hypothermia too fast?

Answer 7

Their catabolic rate increases and they have worse clinical outcomes

So, a rate of rewarming should not exceed 0.25-0.5 ^oC/hour