If an individual has a return of spontaneous circulation (ROSC), start post-cardiac arrest care immediately. The initial BLS/ACLS processes are meant to save an individual’s life, while 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 mean arterial pressure (MAP) < 65.
- 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”).
- If no advanced airway, 30:2 compression to ventilation ratio.
- 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 is the only documented intervention that improves/enhances brain recovery after cardiac arrest. It can be performed in unresponsive individuals (i.e., comatose) and should be continued for at least 24 hours. The goal of induced hypothermia is to maintain a core body temperature between 89.6 to 93.2 degrees F (32 to 36 degrees C). Device manufacturers have developed several innovative technologies that improve the ability to affect and manage hypothermia in the post-arrest individual. 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.