Post Cardiac Arrest Care

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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.

Take Note

As recommended by the 2015 guidelines update, rescuers and providers must go through a focused debriefing to improve performance.

THERAPEUTIC HYPOTHERMIA

  • 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.

NEUROLOGICAL CARE

  • 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.
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