Post Cardiac Arrest Care
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| 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
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| 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
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| Which vasopressors are used for post cardiac arrest care? | Epinephrine, Dopamine, or Norepinephrine
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| 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
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| What comes next if the patient can follow commands? | Evaluate for STEMI or AMI
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| What the next step if the patient is positive for STEMI or AMI? | Coronary reperfusion, then advanced critical care unit
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| What is the next step if the patient is not positive for STEMI or AMI? | Transfer to advanced critical care unit
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| 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
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| 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.
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| What is the target temperature for therapeutic cooling? | 32 to 43 Celsius or 89.6-93.2 Fahrenheit
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| 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
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| What is the optimal duration of induced hypothermia for the most beneficial effects? | 12 -24 hours
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| How does induced hypothermia affect the decision to perform PCI if indicated? | Concurrent PCI and hypothermia is considered feasible and safe.
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| 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.
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| 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
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| 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.
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| 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.
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