RECOVER guidelines monitoring

Question 1

Describe the GRADE methodology and its application in the development of the RECOVER Guidelines.

Answer 1

The GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) methodology was used to systematically evaluate literature and generate treatment recommendations based on the quality of evidence, risk:benefit relationship, and clinical feasibility.

Question 2

What is the significance of end-tidal CO2 (ETCO2) monitoring during CPR according to the guidelines?

Answer 2

ETCO2 monitoring is significant for verifying correct intubation, identifying return of spontaneous circulation (ROSC), evaluating the quality of CPR, and guiding basic life support measures.

Question 3

What is the minimum target end-tidal CO2 (ETCO2) during CPR according to the 2024 RECOVER Guidelines?

Answer 3

18 mm Hg

Question 4

How can proper endotracheal tube placement be confirmed?

Answer 4

ETCO2 >12mmHg

Question 5

Does ETCO2 below 12mmHg means improper intubation and why?

Answer 5

in poor perfusion states such as CPA, low ETCO2 concentrations do not rule
out tracheal intubation and may instead indicate the need for improved
circulation (eg, improved chest compression technique).
If <12mmHg then confirm ETT placement by direct visualization or auscultation of breath sounds during a scheduled 2-minute cycle
pause

Question 6

T/F: compared to 2012 RECOVER guidelines, new 2024 guidelines recommend to palpate pulse as part of the initial assessment of the unresponsive patient

Answer 6

F. Inaccurate + delay start of BLS

Question 7

When available, what is the recommended min DBP during CPR and why?

Answer 7

A DBP of 30 mm Hg
should ensure a COPP of ≥20 mm Hg in most cases

Question 8

What blodowork values are recommended to be checked during CPR and post ROSC?

Answer 8

• lactate, serial
• BG
• Na
• K
• Ca
• crea after ROSC and q24h

Question 9

What is the proposed mechanism of hypoCa during CPR?

Answer 9

unclear, there is some evidence that ionized calcium complexes with lactate as progressive lactic acidosis develop during CPA

Question 10

At what Ca value is treatment recommended?
How is it recommended to supplement it?

Answer 10

ionized Ca <0.8 mmol/L
- 10% calcium gluconate
(50 mg/kg, IV or IO, over 2–5 min)
- or 10% calcium chloride
(15 mg/kg, IV or IO, over 2–5 min)

Question 11

What are the recommendations for pt at risk of CPA?

Answer 11

• ECG
• BP
• ETCO2
• +/- pulsox

Question 12

What is the reported mechanism of hyperglycemia during CPA?

Answer 12

Hyperglycemia is common during CPA and in the PCA period due to the release of stress hormones such as catecholamines and cortisol, which stimulate gluconeogenesis and glycogenolysis.
This physiological response is part of the body’s attempt to provide sufficient energy substrates during the extreme metabolic demands of CPA.