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Cardiac Arrest Management

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If an individual has a return of spontaneous circulation (ROSC), start post-cardiac arrest care immediately. The initial BLS/ACLS processes are meant to save an individual’s life, while post-cardiac arrest care is meant to optimize ventilation and circulation, preserve the heart and brain tissue/function, and to maintain recommended blood glucose levels. Pay close attention to oxygenation, blood pressure control, the need for percutaneous coronary intervention, and ideal temperature management. The 2020 ILCOR Guidelines recommend formal assessment and support for an individual’s continued physical, cognitive, and psychosocial needs because recovery from a cardiac arrest event continues long after the initial hospitalization. Be sure to remember to address the mental health needs of the First Responders also, and schedule a debriefing for lay rescuers, EMS providers, and hospital-based healthcare workers after a resuscitation event.

AIRWAY MANAGEMENT

  • Early placement of advanced airway
  • Manage respiratory parameters:
    – Keep 10 breaths per minute
    – Pulse Ox goal 92-98%
    – Titrate to PaCO2 35-45 mm Hg
    – Waveform capnography (capnometry) to confirm ETT placement

BLOOD PRESSURE SUPPORT AND VASOPRESSORS

  • Obtain early ECG.
  • Consider blood pressure support in any individual with systolic blood pressure less than 90 mmHg or mean arterial pressure (MAP) less than 65.
  • Unless contraindicated, 1 to 2 liters of IV saline or Lactated Ringer’s is the first intervention.
  • When blood pressure is very low, consider vasopressors (commonly referred to as “pressors”). Vasopressors and inotropes are medications used to create vasoconstriction or increase cardiac contractility, respectively. Consider using the following:
    – Epinephrine is the pressor of choice for individuals who are not in cardiac arrest.
    – Dopamine and phenylephrine are alternatives to epinephrine.
    – Norepinephrine is generally reserved for severe hypotension or as a last-line agent.
  • Titrate the infusion rate to maintain the desired blood pressure.

The Post–Cardiac Arrest Care Algorithm (Figure 30) was updated to emphasize the need to prevent hyperoxia, hypoxemia, and hypotension.

HYPOTHERMIA

Hypothermia is the only documented intervention that improves/enhances brain recovery after cardiac arrest. It can be performed in unresponsive individuals and should be continued for at least 24 hours. The goal of induced hypothermia is to maintain a core body temperature between 89.6 to 96.8 degrees F (32 to 36 degrees C) for at least 24 hours by using a cooling device with a feedback loop. Device manufacturers have developed several innovative technologies that improve the ability to affect and manage hypothermia in the post-arrest individual. Hypothermia should be induced and monitored by trained professionals. Induced hypothermia should not affect the decision to perform percutaneous coronary intervention (PCI), because concurrent PCI and hypothermia are reported to be feasible and safe.

Advanced Cardiac Life Support (ACLS) Recertification Course

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