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ACLS ROSC

Post Cardiac Arrest Care

QuestionAnswer
What are the first steps after ROSC? Optimize ventilation and oxygenation- titrate FIO2 to obtain O2 sat > 94%, consider advanced airway and capnography, do not hyperventilate, begin with 10-12 breaths per minute and titrate to Petco2 of 35-40mm Hg
What follows ventilation and oxygenation in post cardiac arrest care? Treat hypotension (SBP <90) with 1-2 liters of NS or LR may use at 4 degrees Celsius if inducing hypothermia, Vasopressor infusion, Consider treatable causes (H’s and T’s), 12 lead ECG
Which vasopressors are used for post cardiac arrest care? Epinephrine, Dopamine, or Norepinephrine
What are the appropriate doses for vasopressors post cardiac arrest? Epinephrine or Norepinephrine 0.1 – 0.5 mcg/kg per minute (7-35mcg/min in 70kg adult); Dopamine 5-10 mcg per minute. Titrate after initial dose to SBP >90 and mean arterial pressure of >65
What comes next if the patient can follow commands? Evaluate for STEMI or AMI
What the next step if the patient is positive for STEMI or AMI? Coronary reperfusion, then advanced critical care unit
What is the next step if the patient is not positive for STEMI or AMI? Transfer to advanced critical care unit
What if the patient is not able to follow commands? Consider induced hypothermia, then evaluate for STEMI or AMI, Coronary Reperfusion or advanced critical as indicated
What is end-tidal CO2 and how does it tell about circulation? It’s the concentration of carbon dioxide in exhaled air at the end of exhalation. CO2 is trace in atmospheric air, but a mechanism of good circulation to blood to lungs is the trade off of collected CO2 for oxygen.
What is the target temperature for therapeutic cooling? 32 to 43 Celsius or 89.6-93.2 Fahrenheit
What should be avoided in a comatose patient who spontaneously develops a mild degree of hypothermia (>32 Celsius or > 89.6 Fahrenheit) after resuscitation from cardiac arrest? No active re-warming in the first 12-24 hours
What is the optimal duration of induced hypothermia for the most beneficial effects? 12 -24 hours
How does induced hypothermia affect the decision to perform PCI if indicated? Concurrent PCI and hypothermia is considered feasible and safe.
What is the reasoning for obtaining a 12 lead ECG ASAP after ROSC? 12 lead ECG is important to identify STEMI and AMI which requires timely coronary reperfusion therapy in order to optimize patient outcome.
What is the best action following ROSC in an out of hospital situation if STEMI or AMI is detected? Notify receiving hospital so that preparations can be in progress to provide the patient with timely reperfusion therapy
What is the next logical step post PCI or in cases in which the ECG does not show STEMI or AMI? Transfer patient to ICU.
What happens to antiarrhythmic therapy once a patient achieves ROSC? There is no scientific evidence to support the continued administration of antiarrhythmics to achieve prophylaxis post ROSC.