Post cardiac arrest

(Redirected from ROSC)

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

Authors:

Ross Donaldson