August 28, 2016

Immediate Post Cardiac Arrest Care

What happens after a patient is revived matters

Post cardiac arrest care is the 5th link in the AHA adult survival chain. For post cardiac arrest care to be successful, an integrated approach with multiple disciplines is required. Some of the topics covered in post cardiac arrest care include; hemodynamic and ventilation optimization, therapeutic hypothermia, immediate coronary reperfusion with percutaneous coronary intervention (PCS), glycemic control, and neurologic care.

Ventilation Optimization

To reduce the risk of oxygen toxicity during the post cardiac arrest phase, oxygen should be titrated to maintain an arterial oxygen saturation of greater than or equal to 94%. Though excessive ventilation should be avoided as excessive oxygen increases the potential for reduced cerebral blood flow related to a decrease in PaCO2 levels.

Hemodynamic Optimization

Hemodynamic optimization involves treating, if existing, hypotension (systolic blood pressure greater than 90 mm Hg). Hypotension can be treated via the administration of fluids and vasoactive medications. Commonly the targeted mean arterial pressure is equal to or greater than 65 mm Hg. This should allow adequate systemic perfusion, which is what the primary objective is.

Therapeutic Hypothermia

Therapeutic hypothermia has been shown to improve neurological outcomes after cardiac arrest, though for it to be effective, should occur very soon after return of spontaneous circulation (ROSC). Determining whether or not to use induced hypothermia is based off of the patient's ability to answer commands. Inability to give meaningful response to verbal commands means the patient should receive therapeutic Hypothermia.

View Post Cardiac Arrest Algorithm