Post cardiac arrest care: Difference between revisions
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**Prophylaxis unproven
**Prophylaxis unproven
**AHA recommends EEG for comatose patients<ref>Callaway CW, Donnino MW, Fink EL, et al. Part 8: post-cardiac arrest care: 2015 American Heart Association guidelines update for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation. 2015;132(18 Suppl 2):S465–82.</ref>
**AHA recommends EEG for comatose patients<ref>Callaway CW, Donnino MW, Fink EL, et al. Part 8: post-cardiac arrest care: 2015 American Heart Association guidelines update for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation. 2015;132(18 Suppl 2):S465–82.</ref>
**If epileptiform activity present, treat as you would other patients with [[seizure]]
*Minimize Irritation
*Minimize Irritation
**[[Sedation|Sedatives]] +/- paralytics
**[[Sedation|Sedatives]] +/- paralytics

Revision as of 02:31, 10 February 2021

Management

  • Maintain perfusion (cerebral)
  • 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]
    • More recent data suggests that there is no difference in 90 day mortality/neurologic outcomes for immediate vs. delayed angiography in patients who had a shockable rhythm during arrest [2]
  • Aggressively treat hyperglycemia
    • No IV fluids with glucose
    • RISS
  • Aggressive seizure treatment
    • Prophylaxis unproven
    • AHA recommends EEG for comatose patients[3]
    • If epileptiform activity present, treat as you would other patients with seizure
  • Minimize Irritation

Prognostication[4]

  • 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. ↑ “Coronary Angiography after Cardiac Arrest without ST-Segment Elevation.” New England Journal of Medicine, vol. 381, no. 2, Nov. 2019, pp. 188–190., doi:10.1056/nejmc1906523.
  3. ↑ Callaway CW, Donnino MW, Fink EL, et al. Part 8: post-cardiac arrest care: 2015 American Heart Association guidelines update for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation. 2015;132(18 Suppl 2):S465–82.
  4. ↑ 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
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