POST-CARDIAC ARREST CARE
Post-cardiac arrest care begins immediately after return of spontaneous circulation (ROSC). The goals of post-cardiac arrest care are to optimize cardiopulmonary function, treat the underlying cause of the arrest, and prevent further organ damage, particularly to the brain. This phase of care is crucial for improving patient survival and neurological outcomes.
IMMEDIATE POST-ROSC CARE
ACLS providers should focus on the following immediately after ROSC:
- Airway Management: Secure and maintain a patent airway. This often involves endotracheal intubation and mechanical ventilation.
- Breathing and Ventilation: Optimize oxygenation and ventilation. Titrate oxygen to maintain an SpO2 of 92-98%. Monitor ventilation with capnography.
- Circulation: Maintain hemodynamic stability. Treat hypotension (low blood pressure) with intravenous fluids and vasopressors if needed.
- 12-Lead ECG: Obtain a 12-lead ECG to identify any ongoing cardiac ischemia.
- Identify and Treat Reversible Causes: Search for and treat any reversible causes of the cardiac arrest (the “Hs and Ts”).
TARGETED TEMPERATURE MANAGEMENT (TTM)
TTM, previously known as therapeutic hypothermia, is recommended for comatose (unresponsive) patients after ROSC from out-of-hospital cardiac arrest with an initial rhythm of ventricular fibrillation (VF) or pulseless ventricular tachycardia (pVT).
FURTHER MANAGEMENT
- Coronary Angiography: Urgent coronary angiography is recommended for patients with STEMI or suspected acute coronary syndrome after ROSC.
- Neurological Monitoring: Closely monitor the patient’s neurological status.
- Glycemic Control: Maintain tight glycemic control (blood glucose levels).
- Seizure Management: Treat any seizures promptly.
- Multidisciplinary Care: Post-cardiac arrest care requires a multidisciplinary approach involving physicians, nurses, and other healthcare professionals.
TRANSPORT TO AN APPROPRIATE FACILITY
Transfer the patient to an intensive care unit (ICU) capable of providing comprehensive post-cardiac arrest care.