Post Resuscitation Care

Question 1

What is post cardiac arrest syndrome?

Answer 1

PCA Brain Injury

PCA myocardial dysfunction

Systemic ischaemia/reperfusion response

Persistent precipitating pathology

Question 2

Adult Post-Resuscitation Care - Airway and Breathing Step 1?

Answer 2

Maintain SpO2 94-98%
Insert advanced airway
Waveform capnography
Ventilate lungs to normocapnia

Question 3

Adult Post-Resuscitation Care - Circulation Step 2?

Answer 3

12 Lead ECG
Reliable IV access
Aim SBP >100
Restore normovolaemia with fluids
Intra-arterial BP monitoring
Consider vasopressor/inotrope to maintain SBP

Question 4

Adult Post-Resuscitation Care - control temperature Step 3?

Answer 4

Prevent fever
Sedation, control shivering

Question 5

Adult Post-Resuscitation Care - if likely cardiac cause Step 4?

Answer 5

12 Lead ECG
1. ST Elevation/LBBB - Coronary Angiography +/- PCI
2. No ST Elevation - Consider Coronary Angiography +/- PCI

If no cause for cardiac arrest identified on PCI?
1. Consider CT brain and/or CTPA
2. Treat non cardiac cause for cardiac arrest

If cause for cardiac arrest identified?
1. Admit to ICU

Question 6

Adult Post-Resuscitation Care - ITU management Step 5?

Answer 6

Temperature control, prevent fever for at least 72 hours

Maintain normoxia/normocapnia

Avoid hypotension

Echo

Normoglycaemia

Diagnoses/treat seizures (EEG, sedation, AEDs)

Delay prognostication until at least 72 hours

Question 7

Adult Post-Resuscitation Care - prior to discharge?

Answer 7

Functional assessments (clinical exam, SSEPs/EEG, NSE biomarker, CT/MRI brain)

Structured follow up after hospital discharge

Rehabilitation

Question 8

Adult Post-Resuscitation Care - secondary prevention?

Answer 8

ICD (shockable rhythm outside context of proven STEMI)

Screen for inherited disorders

Risk management