Post cardiac arrest care: Difference between revisions

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==Treatment==
==Management==
#Maintain perfusion (cerebral)
*Maintain perfusion (cerebral)
##Tx hypotension
**Treat hypotension
##ignore HTN
**Ignore hypertension
##normal PaCO2 (~40)
**Maintain normal PaCO2 (~40)
#Normoxia
*Target Normoxia
##PaO2 80-120
**PaO2 80-120
#Mild Hypothermia (except in trauma)
*[[Therapeutic Hypothermia]]
##32-34 deg C for 12-24 hrs
*PCI
##aggresivly Tx hyperthermia (acetamin)
**Early reperfusion therapy is important to ID coronaries as ECG cannot reliably predict them in these cases<ref>Kern, KB. Optimal Treatment of Patients Surviving Out-of-Hospital Cardiac Arrest. J Am Coll Cardiol Intv. 2012; 5(6):597-605. doi:10.1016/j.jcin.2012.01.017</ref>
##prevent shivering (meperidine, buspirone, and/or dexmetomidine)
*Aggressively treat hyperglycemia
#Aggressively Tx hyperglycemia
**No IV fluids with glucose
##no IVFs with glucose
**RISS
##RISS
*Aggressive seizure treatment
#Aggressive Seizure Tx
**Prophylaxis unproven
##prophylaxis unproven
*Minimize Irritation
#Minimize Irritation
**Sedatives +/- paralytics
##sedatives +/- paralytics
**Supine positioning
##supine flat
 
==Prognostication<ref>Breu AC. Clinician-Patient Discussions of Successful CPR—The Vegetable Clause. JAMA Intern Med. 2018;178(10):1299–1300. doi:10.1001/jamainternmed.2018.4066</ref>==
*Out-of-hospital cardiac arrest (OHCA) has about a 10% survival to discharge rate
*In-hospital cardiac arrest has just over a 20% survival to discharge rate
**About half will have no to mild disability, and the other half will have moderate to severe disability
*Lack of pupillary reflexes upon ROSC after OHCA are not reliable in prognosticating return of neurologic function


==See Also==
==See Also==
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*[[Adult Cardiac Arrest]]
*[[Adult Cardiac Arrest]]


==Source==
==References==
2/17/06  DONALDSON (adapted from Rosen)
<references/>


[[Category:Cards]]
[[Category:Cardiology]]

Revision as of 06:37, 20 June 2019

Management

  • Maintain perfusion (cerebral)
    • Treat hypotension
    • Ignore hypertension
    • Maintain normal PaCO2 (~40)
  • Target Normoxia
    • PaO2 80-120
  • Therapeutic Hypothermia
  • PCI
    • Early reperfusion therapy is important to ID coronaries as ECG cannot reliably predict them in these cases[1]
  • Aggressively treat hyperglycemia
    • No IV fluids with glucose
    • RISS
  • Aggressive seizure treatment
    • Prophylaxis unproven
  • Minimize Irritation
    • Sedatives +/- paralytics
    • Supine positioning

Prognostication[2]

  • Out-of-hospital cardiac arrest (OHCA) has about a 10% survival to discharge rate
  • In-hospital cardiac arrest has just over a 20% survival to discharge rate
    • About half will have no to mild disability, and the other half will have moderate to severe disability
  • Lack of pupillary reflexes upon ROSC after OHCA are not reliable in prognosticating return of neurologic function

See Also

References

  1. Kern, KB. Optimal Treatment of Patients Surviving Out-of-Hospital Cardiac Arrest. J Am Coll Cardiol Intv. 2012; 5(6):597-605. doi:10.1016/j.jcin.2012.01.017
  2. Breu AC. Clinician-Patient Discussions of Successful CPR—The Vegetable Clause. JAMA Intern Med. 2018;178(10):1299–1300. doi:10.1001/jamainternmed.2018.4066