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==
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==Management==
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*Maintain perfusion (cerebral)
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**Treat [[hypotension]]
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**Ignore [[hypertension]]
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**Maintain normal PaCO2 (~40)
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*Target [[oxygen|normoxia]]
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**PaO2 80-120
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*[[Therapeutic Hypothermia]]
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*PCI
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**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>
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**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>
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*Aggressively treat [[hyperglycemia]]
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**No IV fluids with glucose
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**RISS
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*Aggressive [[seizure]] treatment
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**Prophylaxis unproven
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**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>
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**If epileptiform activity present, treat as you would other patients with [[seizure]]
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*Minimize Irritation
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**[[Sedation|Sedatives]] +/- paralytics
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**Supine positioning
  
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==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>==
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*Out-of-hospital cardiac arrest (OHCA) has about a 10% survival to discharge rate
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*In-hospital cardiac arrest has just over a 20% survival to discharge rate
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**About half will have no to mild disability, and the other half will have moderate to severe disability
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*Lack of pupillary reflexes upon ROSC after OHCA are not reliable in prognosticating return of neurologic function
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*Recommended to wait minimum of 72 hours post-ROSC for prognostication
  
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1)  Maintain perfusion (cerebral)
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==See Also==
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*[[ACLS (Main)]]
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*[[Adult Cardiac Arrest]]
  
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    -Tx hypotension
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==References==
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<references/>
  
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    -ignore HTN
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[[Category:Cardiology]]
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    -normal PaCO2 (~40)
 
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2)  Normoxia
 
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    -PaO2 80-120
 
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3)  Mild Hypothermia (except in trauma)
 
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    -32-34 deg C for 12-24 hrs
 
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    -aggresivly Tx hyperthermia (acetamin)
 
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    -prevent shivering (meperidine, buspirone, and/or dexmetomidine)
 
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4)  Aggressively Tx hyperglycemia
 
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    -no IVFs with glucose
 
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    -RISS
 
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5)  Aggressive Seizure Tx
 
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    -prophylaxis unproven
 
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6)  Minimize Irritation
 
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    -sedatives +/- paralytics
 
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    -supine flat
 
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==Source==
 
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2/17/06  DONALDSON (adapted from Rosen)
 
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[[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
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