The final link in the Adult Chain of Survival, and perhaps one of the most important ones, is integrated post-cardiac arrest care. High-quality care is crucial for allowing resuscitated individuals the best chance at a full recovery. By integrating the interventions provided below, the likelihood of survival and recovery is much higher.
As recommended by the 2015 guidelines update, rescuers and providers must go through a focused debriefing to improve performance.
- This is for comatose individuals who, after a cardiac arrest event, experience a return of spontaneous circulation.
- For at least 24 hours, individuals must be cooled to a temperature of 89.6 to 93.2 degrees F (32 to 36 degrees C).
OPTIMIZATION OF HEMODYNAMICS AND VENTILATION
- For early intervention, 100% oxygen is acceptable, but this shouldn’t be continued over an extended period of time.
- To prevent oxygen toxicity, the individual’s pulse oximetry must be greater than 94% by titrating the oxygen.
- Adverse hemodynamic effects can be caused by over-ventilating.
- In achieving ETCO2 at 35 to 40mmHg, you must reach ventilation rates of 10 to 12 breaths per minutes.
- Titrate the IV fluids and vasoactive medications to achieve hemodynamic stability.
PERCUTANEOUS CORONARY INTERVENTION (PCI)
- Percutaneous coronary intervention (PCI) is generally preferred over thrombolytics.
- EMS shoul take individuals directly to hospitals that provide PCI.
- If time permits, a patient that has been taken to a center that does not provide PCI and only thrombolytics needs to be transferred to a center with PCI.
- To lessen false positive rates, an important element is the neurological assessment, specifically when withdrawing care. Keep track of symptoms and neurological signs during the post-resuscitation period by obtaining specialty consultation.