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POST-CARDIAC ARREST CARE

Integrated post-cardiac arrest care is the last link in the Chain of Survival. The quality of this care is critical to providing resuscitated patients with the best possible results. When the interventions below are provided there is an increased likelihood of survival.

THERAPEUTIC HYPOTHERMIA

  • Recommended for comatose patients with return of spontaneous circulation after a cardiac arrest event.
  • Patients should be cooled to 89.6 to 93.2° F for 12 to 24 hours.

OPTIMIZATION OF HEMODYNAMICS AND VENTILATION

  • 100% oxygen is acceptable for early intervention, but not for extended periods of time.
  • Oxygen should be titrated so that patient pulse oximetry is > 94% to avoid O2 toxicity.
  • Do NOT over-ventilate to avoid potential adverse hemodynamic effects.
  • Ventilation rates of 10 to 12 breaths per minute to achieve PETCO2 at 35 to 40 mmHg.
  • IV fluids and vasoactive medications should be titrated for hemodynamic stability.

PERCUTANEOUS CORONARY INTERVENTION (PCI)

  • PCI is preferred over thrombolytics.
  • Patient should be taken by EMS directly to hospital that performs PCI.
  • If the patient is delivered to a center that only delivers thrombolytics, the patient should be transferred to a center that offers PCI if time permits.

GLUCOSE CONTROL

  • Optimal blood glucose is 144 to 180 mg/dL in patients with Return of Spontaneous Circulation (ROSC) after cardiac arrest.
  • This is higher than standard levels to improve glucose delivery to tissues and avoid hypoglycemia.

NEUROLOGICAL CARE

  • Neurologic assessment is key, especially when withdrawing care (i.e., brain death) to decrease false positive rates.