Cardiac Arrest Management

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Post-cardiac arrest care must begin immediately after a patient experiences ROSC, or a return of spontaneous circulation. The initial processes of BLS and ACLS are focused on saving the patient’s life; post-cardiac arrest care focuses on opening up ventilation and circulation in the body, keeping the heart and brain tissue safe, and securing blood glucose at recommended levels.

Blood Pressure Support and Vasopressors

  • Any individual who has systolic blood pressure that is less than 90mm Hg or mean arterial pressure (MAP) less than 65 should be considered for blood pressure support.
  • The first intervention should be 1 to 2 liters of IV saline or Lactated Ringer’s, unless contraindicated.
  • Consider vasopressors (also known as “pressors”) when blood pressure is extremely low.
  • Without an advanced airway, use a 30:2 compression to ventilation ratio.
    • Individuals not in cardiac arrest should be administered with epinephrine.
    • Alternatives to epinephrine are methoxamine, phenylephrine, and dopamine.
    • As a last-line agent or for severe hypotension, you would generally use norepinephrine.
  • To keep a desired blood pressure, titrate the infusion rate.

Hypothermia

After cardiac arrest, the only documented intervention that enhances or improves brain recovery is hypothermia. This should be continued for around 24 hours, and it must be performed in comatose or unresponsive individuals. You must keep a core body temperature of 89.6 to 93.2 degrees F (32 to 36 degrees C), as this is the goal of induced hypothermia. The post-arrest patient must have his or her hypothermia managed, and device manufacturers have created several technologies that improve our ability to do this. Trained professionals are required when inducing and monitoring hypothermia. Since concurrent PCI and hypothermia have been known to be both safe and feasible, induced hypothermia should not then influence one’s consideration regarding performing percutaneous coronary intervention (PCI).

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