Post–Cardiac Arrest Care

Initial objectives
of Post–Cardiac Arrest Care
•Optimize cardiopulmonary function and vital organ
perfusion.
•Transport patient to hospital or unit with
comprehensive post–cardiac arrest treatment system
–acute coronary interventions
–neurological care
–goal-directed critical care
–hypothermia
•Try to identify and treat the precipitating causes of
the arrest and prevent recurrent arrest.
 Subsequent Objectives
of Post–Cardiac Arrest Care
•Control body temperature to optimize neurologically
intact survival
•Identify and treat acute coronary syndromes (ACS)
•Optimize mechanical ventilation to minimize lung
injury
•Reduce the risk of multi-organ injury and support
organ function if required
•Objectively assess prognosis for recovery
•Assist survivors with rehabilitation services when
required
POST CARDIAC AREST CARE
ALGORITHM
POST CARDIAC AREST CARE
ALGORITHM
POST CARDIAC AREST CARE
ALGORITHM
Multiple System Approach to Post–Cardiac
Arrest Care: Neurological

•Serial Neurological Exam

–Check response to verbal commands or
physical stimulation
–Pupillary light and corneal reflex, spontaneous
eye movement
–Gag, cough, spontaneous breaths
•EEG Monitoring If Comatose
–To exclude seizures
–Early and aggressive Anticonvulsants if seizing!
Multiple System Approach to Post–Cardiac
Arrest Care: Neurological

•Temperature Management If Comatose

–To minimize brain injury and improve outcome
–Prevent hyperpyrexia > 37.7°C
–Induce therapeutic hypothermia if no contraindications
within 6-12 hrs of arrest
–Cold IV fluid bolus 30 mL/kg if no contraindication
–Surface or endovascular cooling for 32°C–34°C x 12-
24 hours
–After 24 hours, slow rewarming 0.25°C/hr
•Consider Non-enhanced CT Scan
–to exclude primary intracranial process
Multiple System Approach to Post–Cardiac
Arrest Care: Neurological

•Sedation/Muscle Relaxation
–To control shivering, agitation, or
ventilator dysynchrony as needed
Multiple System Approach to Post–Cardiac Arrest
Care: Hemodynamics

• Frequent Blood Pressure Monitoring/Arterial-

line
– MAP > 65 mm Hg or SBP > 90 mm Hg

•Treat Hypotension
– Fluid bolus if tolerated (1-2 L pNSS or pLR, chilled
to 4°C if inducing hypothermia)
– Dopamine 5–10 mcg/kg/min
– Norepinephrine 0.1–0.5 mcg/kg/min
– Epinephrine 0.1–0.5 mcg/kg/min
Multiple System Approach to Post–Cardiac
Arrest Care: Cardiovascular

• Continuous Cardiac Monitoring

–to detect recurrent arrhythmia
–No prophylactic antiarrhythmics
–Treat arrhythmias as required
–Remove reversible causes
•12-lead ECG / Troponin (I & T)
–To detect ACS/STEMI; Assess QT interval
Multiple System Approach to Post–Cardiac
Arrest Care: Cardiovascular
•Treat Acute Coronary Syndrome

–Aspirin/heparin (LMWH)
–Transfer to acute coronary treatment center
–Consider emergent PCI or fibrinolysis
•Echocardiogram

–To detect global stunning, wall-motion

abnormalities, structural problems or
cardiomyopathy