Post-ROSC Care

Question 1

In veterinary medicine what percentage of patients that achieve ROSC die or are euthed?

Answer 1

85% - Source CCM

Question 2

What are the 4 main pathophysiological processes that occur post-cardiac arrest?

Answer 2

(1) ischemia and reperfusion (IR) injury,
(2) PCA brain injury,
(3) PCA myocardial dysfunction,
(4) persistent precipitating pathologic conditions
Source: CCM

Question 3

What is the target PCO2 in dogs and cats post-cardiac arrest?

Answer 3

Dogs 32-43mmHg and cats is 26-36mmHg

Question 4

What is post-arrest syndrome similar to?

Answer 4

Sepsis - Source CCM

Question 5

What are common interventions in early, goal-directed therapy post-arrest?

Answer 5

Included interventions are those to optimize tissue
oxygen delivery (fluid administration, vasopressors/inotropes, red
blood cell transfusion, oxygen supplementation) and to decrease
tissue oxygen demand (sedation, mechanical ventilation, neuromuscular
blockade, temperature control).
- Source CCM

Question 6

What are ideal haemodynamic endpoints post-arrest?

Answer 6

central venous pressure
(CVP; 0 mm Hg < CVP < 10 mm Hg), mean arterial blood pressure
(MAP 80 to 120 mm Hg), and perfusion parameters (central venous
oxygen saturation [ScvO2] > 70 %; lactate < 2.5 mmol/L
Should also look at CRT and MMs, pulses, echo
- Source CMM

Question 7

Why does hyperglycaemia occur after CPA?

Answer 7

60% insulin decrease - Source CMM

Question 8

Why should hyperglycaemia be avoided?

Answer 8

It worsens brain injury and neural dysfunction. - Source CMM

Question 9

What are the aspects of cerebral ischemia-reperfusion injury

Answer 9

Most of the injury is sustained during reperfusion and not during
ischemia, affording the clinician the opportunity to intervene after
ROSC is achieved.
2. Cytosolic and mitochondrial calcium overload leads to activation
of proteases that may lead to neuronal death and production of
reactive oxygen species (ROS).57,58
3. A burst of ROS occurs during reperfusion, leading to oxidative
alterations of lipids, proteins, and nucleic acids propagating injury
of neuronal cell components and limiting the cells’ protective and
repair mechanisms.56
4. Mild therapeutic hypothermia administered after ROSC is proven
to reduce postresuscitation cerebral dysfunction
- Source CMM

Question 10

What is involved in controlled reperfusion?

Answer 10

Mild hypocalcaemia and avoidance of hyperoxaemia. Source CMM

Question 11

why should hyperoxaemia be avoided ?

Answer 11

increases oxidative brain injury, increases neurodegeneration,
worsens functional neurologic outcome, and negatively affects overall
survival
Source - CCM

Question 12

What SPO2 should be targeted in post-arrest care?

Answer 12

94-96%, PaO2 of 80-100mmHg - to avoid hyperoxaemia and the increase in ROS.
Source - CCM

Question 13

When initiating mild hypothermia post-arrest, what temperatures are the goal?

Answer 13

32-34 celcius.

Source - CCM

Question 14

How is mild hypothermia helpful post-arrest?

Answer 14

Protective effects via a number of processes, including a reduction of mitochondrial injury and dysfunction, decrease in cerebral metabolism, reduction of calcium inflow into cells and neuronal excitotoxicity, reduced production of ROS and reduced apoptosis, and suppression of seizure activity
Source CCM

Question 15

How long should mild hypothermia be maintained post-arrest?

Answer 15

24-48hrs after rosc

Source CCM

Question 16

Following the institution of mild hypothermia how fast should rewarming occur?

Answer 16

0.25-0.5 degrees per hour

Source - CCM

Question 17

What situations are required to institute mild hypothermia in veterinary medicine?

Answer 17

requires sedation, endotracheal intubation, and ventilation. Cooling without sedation may abolish the protective effect of MTH. This is because Cooling induces increased muscle tone and shivering, which in return leads to increased oxygen consumption, metabolic rate, and respiratory and heart rates.
Source CCM

Question 18

How often should neuro exams be performed post-arrest?

Answer 18

Directly after ROSC and every 2-4hrs in humans not until three days after ROSC does lack of PLR and response to painful stimuli indicate a poor outcome.
Source CCM

Question 19

How is PCA myocardial dysfunction characterised?

Answer 19

increased central venous and pulmonary capillary wedge pressure,
reduced left- and right sided systolic and diastolic ventricular function
with increased end-diastolic and end-systolic volume, and
reduced left ventricular ejection fraction and cardiac output
Source CCM

Question 20

over what period of time does myocardial dysfunction typically resolve post-arrest?

Answer 20

48hrs

Source - CCM