Post cardiac arrest care: Difference between revisions

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==Management==
==Management==
*Maintain perfusion (cerebral)
*Maintain perfusion (cerebral)
**Treat hypotension
**Treat [[hypotension]]
**Ignore hypertension
**Ignore [[hypertension]]
**Maintain normal PaCO2 (~40)
**Maintain normal PaCO2 (~40)
*Target Normoxia
*Target [[oxygen|normoxia]]
**PaO2 80-120
**PaO2 80-120
*[[Therapeutic Hypothermia]]
*[[Therapeutic Hypothermia]]
*PCI
*PCI
**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>
**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>
*Aggressively treat hyperglycemia
*Aggressively treat [[hyperglycemia]]
**No IV fluids with glucose
**No IV fluids with glucose
**RISS
**RISS
*Aggressive seizure treatment
*Aggressive [[seizure]] treatment
**Prophylaxis unproven
**Prophylaxis unproven
*Minimize Irritation
*Minimize Irritation
**Sedatives +/- paralytics
**[[Sedation|Sedatives]] +/- paralytics
**Supine positioning
**Supine positioning



Revision as of 17:03, 25 September 2019

Management

  • Maintain perfusion (cerebral)
  • 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

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