Viva - Post Cardiac Arrest Care

Question 1

Mortality follow cardiac arrest

Answer 1

All cause out of hospital - 8.6%

OOH with early CPR and defib > in hospital with deterioration (usually non-shockable)

Depends on cause, age, and setting

Question 2

What makes up the post caridac arrest syndome

Answer 2

Triad of:

Myocardial Dysfunction

Reperfusion injury

Hypoxic brain injury

Question 3

Describe the myocardial dysfunction

Answer 3

Known as myocaridal stunning

Early echo - poor global function, generally improves

May be so severe that there is low cardiac output —> responds to inotropes

Early echo should be avoided unless suspicious of valve rupture or LV aneurysm

Question 4

Describe the Reperfusion Syndrome

Answer 4

Ischaemic tissue re-perfused

Cytokines and hypoxic metabolites released

Leads to VASOPLEGIA
Impaired oxygen utilisation
Hypotension —> may respond to vasopressors and filling

Question 5

Describe the hypoxic brain injury

Answer 5

Hypoxaemia —> primary injuiry by brain cell apoptosis

Secondary injury —> impaired cerebral autoregulation and cerebral oedema

Neuroprotection as per head injury

Attention to oxygenation and ventilation

Maintain CPP, Na, glucose and seizure control

Question 6

Management priorities post cardiac arrest

Answer 6

Airway - specially when GCS is low
Adequate oxygenation and maintain normal CO2.

Maintain CPP —> raise MAP, fluid, vasopressor, inotropes

Sedation

Find the cause —> pPCI

Avoid hyperthermia

Maintain normoglycaemia

Control of seizures

Question 7

Poor prognostic indicators

Answer 7

Unwitnessed arrest - no bystander

PEA as initial rhythm

BLS longer than 10 minutes
ALS longer than 20-25 minutes

Question 8

Neuro prognostication

Answer 8

Absences of pupil/corneal reflexes

Motor score < 2

Myoclonus status, NOT post hypoxic myoclonus (Lance Adams Syndrome)

Neurone specific enolase levels

Absence of N2O spike on SSEP

Burst supression/epileptiform discharges —> hypoxic encephalopathy