Difference between revisions of "Post cardiac arrest care"

(Created page with "==Treatment== 1) Maintain perfusion (cerebral) -Tx hypotension -ignore HTN -normal PaCO2 (~40) 2) Normoxia -PaO2 80-120 3) Mild Hypothermia (except...")
 
m (Rossdonaldson1 moved page Post cardiac arrest to Post cardiac arrest care)
 
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==Treatment==
+
==Management==
 +
*Maintain perfusion (cerebral)
 +
**Treat [[hypotension]]
 +
**Ignore [[hypertension]]
 +
**Maintain normal PaCO2 (~40)
 +
*Target [[oxygen|normoxia]]
 +
**PaO2 80-120
 +
*[[Therapeutic Hypothermia]]
 +
*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>
 +
**More recent data suggests that there is no difference in 90 day mortality/neurologic outcomes for immediate vs. delayed angiography in patients who had a shockable rhythm during arrest <ref>“Coronary Angiography after Cardiac Arrest without ST-Segment Elevation.” New England Journal of Medicine, vol. 381, no. 2, Nov. 2019, pp. 188–190., doi:10.1056/nejmc1906523.</ref>
 +
*Aggressively treat [[hyperglycemia]]
 +
**No IV fluids with glucose
 +
**RISS
 +
*Aggressive [[seizure]] treatment
 +
**Prophylaxis unproven
 +
**AHA recommends EEG for comatose patients<ref>Callaway CW, Donnino MW, Fink EL, et al. Part 8: post-cardiac arrest care: 2015 American Heart Association guidelines update for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation. 2015;132(18 Suppl 2):S465–82.</ref>
 +
**If epileptiform activity present, treat as you would other patients with [[seizure]]
 +
*Minimize Irritation
 +
**[[Sedation|Sedatives]] +/- paralytics
 +
**Supine positioning
  
 +
==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
 +
*Recommended to wait minimum of 72 hours post-ROSC for prognostication
  
1)  Maintain perfusion (cerebral)
+
==See Also==
 +
*[[ACLS (Main)]]
 +
*[[Adult Cardiac Arrest]]
  
    -Tx hypotension
+
==References==
 +
<references/>
  
    -ignore HTN
+
[[Category:Cardiology]]
 
 
    -normal PaCO2 (~40)
 
 
 
2)  Normoxia
 
 
 
    -PaO2 80-120
 
 
 
3)  Mild Hypothermia (except in trauma)
 
 
 
    -32-34 deg C for 12-24 hrs
 
 
 
    -aggresivly Tx hyperthermia (acetamin)
 
 
 
    -prevent shivering (meperidine, buspirone, and/or dexmetomidine)
 
 
 
4)  Aggressively Tx hyperglycemia
 
 
 
    -no IVFs with glucose
 
 
 
    -RISS
 
 
 
5)  Aggressive Seizure Tx
 
 
 
    -prophylaxis unproven
 
 
 
6)  Minimize Irritation
 
 
 
    -sedatives +/- paralytics
 
 
 
    -supine flat
 
 
 
 
 
 
==Source==
 
 
 
 
 
2/17/06  DONALDSON (adapted from Rosen)
 
 
 
 
 
 
 
 
 
 
 
 
[[Category:Cards]]
 

Latest revision as of 20:54, 27 February 2021

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]
    • More recent data suggests that there is no difference in 90 day mortality/neurologic outcomes for immediate vs. delayed angiography in patients who had a shockable rhythm during arrest [2]
  • Aggressively treat hyperglycemia
    • No IV fluids with glucose
    • RISS
  • Aggressive seizure treatment
    • Prophylaxis unproven
    • AHA recommends EEG for comatose patients[3]
    • If epileptiform activity present, treat as you would other patients with seizure
  • Minimize Irritation

Prognostication[4]

  • 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
  • Recommended to wait minimum of 72 hours post-ROSC for prognostication

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. “Coronary Angiography after Cardiac Arrest without ST-Segment Elevation.” New England Journal of Medicine, vol. 381, no. 2, Nov. 2019, pp. 188–190., doi:10.1056/nejmc1906523.
  3. Callaway CW, Donnino MW, Fink EL, et al. Part 8: post-cardiac arrest care: 2015 American Heart Association guidelines update for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation. 2015;132(18 Suppl 2):S465–82.
  4. 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