Post–Cardiac Arrest Care
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 View more presentations or Upload your own.
- Rationale: Confirm secure airway and titrate ventilation
- PETCO2 ~35–40 mmHg
- PaCO2 ~40–45 mmHg
- 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)
- 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%
- Rationale: Maintain perfusion and prevent recurrent hypotension
- MAP≧65 mmHg or SBP≧90 mmHg
- 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
- Rationale: Detect recurrent arrhythmia
- No prophylactic antiarrhythmicsTreat arrhythmias as required
- Rationale:Detect ACS/STEMI; Assess QT interval.
- Aspirin/heparin
- Transfer to acute coronary treatment center
- Consider emergent PCI or fibrinolysis
- Rationale: Detect global stunning, wall-motion abnormalities, structural problems or cardiomyopathy
- Fluids to optimize volume status
- Dobutamine 5–10 mcg/kg per min
- Mechanical augmentation (IABP)
- 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
- Rationale: Exclude seizures
- Anti-convulsants if seizing
- 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
- Rationale: Exclude primary intracranial process
- Rationale: To control shivering, agitation, or ventilator desynchrony as needed
- Rationale: Confirm adequate perfusion
- Rationale: Avoid hypokalemia which promotes arrhythmias
- Replace to maintain K >3.5 mEq/L
- Rationale: Detect acute kidney injury
- Maintain euvolemia
- Renal replacement therapy if indicated
- Rationale: Detect hyperglycemia and hypoglycemia
- Treat hypoglycemia (<80 mg/dL) with dextrose
- Treat hyperglycemia to target glucose144–180 mg/dL
- Local insulin protocols
