Menu

POST-CARDIAC ARREST CARE

If a patient has a Return of Spontaneous Circulation (ROSC), start Post-Cardiac Arrest Care immediately. The initial BLS/ACLS processes are meant to save a patient's life. Post-Cardiac Arrest Care is meant to optimize ventilation and circulation, preserve heart and brain tissue/function, and maintain recommended blood glucose levels.

BLOOD PRESSURE SUPPORT AND VASOPRESSORS

  • Consider blood pressure support in any patient with systolic blood pressure < 90 mmHg
  • Unless contraindicated, 1 to 2 liters of IV saline or Lactated Ringer’s is the first intervention
  • When blood pressure is very low, consider vasopressors (commonly referred to as "pressors")
    • Epinephrine is the pressor of choice for patients who are not in cardiac arrest
    • Dopamine, phenylephrine, and methoxamine are alternatives
    • Norepinephrine is generally reserved for severe hypotension or as a last-line agent
  • Titrate the infusion rate to maintain the desired blood pressure.

HYPOTHERMIA

Hypothermia is the ONLY documented intervention that improves/enhances brain recovery after cardiac arrest. It can be performed in unresponsive patients (i.e., comatose) and should be continued for at least 12 to 24 hours. The goal of induced hypothermia is to reach a core body temperature between 89.6° F and 93.2° F. Hypothermia can be induced by infusing ice-cold saline or Lactated Ringer's during blood pressure support and maintained by surface cooling devices. Device manufacturers have developed several innovative technologies that improve the ability to effect and manage hypothermia in the post-arrest patient. Hypothermia should be induced and monitored by trained professionals. Induced hypothermia should not affect the decision to perform percutaneous coronary intervention (PCI) because concurrent PCI and hypothermia are reported to be feasible and safe.