Post–Cardiac Arrest Care

Post–Cardiac Arrest Care

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Post–Cardiac Arrest Care 2010 AHA Guidelines for CPR and ECC Circulation 2010;122:S768-S786 Multiple System Approach to Post–Cardiac Arrest Care 1. Ventilation Capnography

• Rationale: Confirm secure airway and titrate ventilation
• PETCO2 ~35–40 mmHg
• PaCO2 ~40–45 mmHg

Pulse Oximetry/ABG 

• Rationale: Maintain adequate oxygenation and minimize FiO2 
• SpO2 ~94%; PaO2 ~100 mmHg 
• Reduce FiO2 as tolerated 
• PaO2/FiO2 ratio to separate acute lung injury/ARDS (<300 or <200)

Mechanical Ventilation

• Rationale: Minimize acute lung injury,potential oxygen toxicity
• Tidal Volume 6–8 mL/kg
• Titrate minute ventilation to PETCO2 ~35–40 mm Hg; PaCO2 ~40–45 mm Hg
• Reduce FiO2 as tolerated to keepSpO2 or SaO2 ≧94%

2. Hemodynamics Frequent BP Monitoring/Arterial-line

• Rationale: Maintain perfusion and prevent recurrent hypotension
• MAP≧65 mmHg or SBP≧90 mmHg

Treat Hypotension

• Rationale: Maintain perfusion
• Fluid bolus if tolerated
• Dopamine 5–10 mcg/kg per min
• Norepinephrine 0.1–0.5 mcg/kg per min
• Epinephrine 0.1–0.5 mcg/kg per min

3. Cardiovascular Continuous Cardiac Monitoring

• Rationale: Detect recurrent arrhythmia
• No prophylactic antiarrhythmicsTreat arrhythmias as required

12-lead ECG/Troponin

• Rationale:Detect ACS/STEMI; Assess QT interval.

Treat Acute Coronary Syndrome

• Aspirin/heparin
• Transfer to acute coronary treatment center
• Consider emergent PCI or fibrinolysis

Echocardiogram

• Rationale: Detect global stunning, wall-motion abnormalities, structural problems or cardiomyopathy

Treat Myocardial Stunning

• Fluids to optimize volume status
• Dobutamine 5–10 mcg/kg per min
• Mechanical augmentation (IABP)

4. Neurological Serial Neurological Exam

• Rationale: Serial examinations define coma, brain injury, and prognosis
• Response to verbal commands or physical stimulation
• Pupillary light and corneal reflex, spontaneous eye movement
• Gag, cough, spontaneous breaths

EEG Monitoring If Comatose

• Rationale: Exclude seizures
• Anti-convulsants if seizing

Core Temperature Measurement If Comatose

• Rationale: Minimize brain injury and improve outcome
• Prevent hyperpyrexia >37.7°C
• Induce therapeutic hypothermia
• Cold IV fluid bolus 30 mL/kg
• Surface or endovascular cooling for 32–34°C x24 hours
• After 24 hours, slow rewarming 0.25°C/hr

Consider Non-enhanced CT

• Rationale: Exclude primary intracranial process

Sedation/Muscle Relaxation

• Rationale: To control shivering, agitation, or ventilator desynchrony as needed

5. Metabolic Serial Lactate

• Rationale: Confirm adequate perfusion

Serum Potassium

• Rationale: Avoid hypokalemia which promotes arrhythmias
• Replace to maintain K >3.5 mEq/L

Urine Output, Serum Creatinine

• Rationale: Detect acute kidney injury
• Maintain euvolemia
• Renal replacement therapy if indicated

Serum Glucose

• Rationale: Detect hyperglycemia and hypoglycemia
• Treat hypoglycemia (<80 mg/dL) with dextrose
• Treat hyperglycemia to target glucose144–180 mg/dL
• Local insulin protocols

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