Integrated post-cardiac arrest care is the fifth link in the Adult Chain of Survival. The quality of this care is critical to providing resuscitated individuals with the best possible results. When the interventions below are provided, there is an increased likelihood of survival.
Care of the patient after the return of spontaneous circulation (ROSC) requires close attention to oxygenation, blood pressure control, evaluation for percutaneous coronary intervention, targeted temperature management, and multimodal neuroprognostication. Because recovery from cardiac arrest continues long after the initial hospitalization, patients should have formal assessment and support for their physical, cognitive, and psychosocial needs.
After a resuscitation, debriefing for lay rescuers, EMS providers, and hospital-based healthcare workers may be beneficial to support their mental health and well-being.
TARGETED TEMPERATURE MANAGEMENT
- Recommended for comatose individuals with the return of spontaneous circulation after a cardiac arrest event.
- Individuals should be cooled to 89.6 to 93.2 degrees F (32 to 36 degrees C) for at least 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 individual’s pulse oximetry is greater than 94% to avoid oxygen toxicity.
- Do not over ventilate to avoid potential adverse hemodynamic effects.
- Ventilation rates of 10 to 12 breaths per minute to achieve ETCO2 at 35 to 40 mmHg.
- IV fluids and vasoactive medications should be titrated for hemodynamic stability.
- Tight glycemic control for best patient outcome.
PERCUTANEOUS CORONARY INTERVENTION
- Percutaneous coronary intervention (PCI) is preferred over thrombolytics.
- Individual should be taken by EMS directly to a hospital that performs PCI.
- If the individual is delivered to a center that only delivers thrombolytics, they should be transferred to a center that offers PCI if time permits.
- Neurologic assessment is key, especially when withdrawing care (i.e., brain death) to decrease false-positive rates. Specialty consultation should be obtained to monitor neurologic signs and symptoms throughout the post-resuscitation period.