Post cardiac arrest care: Difference between revisions
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== | ==Management== | ||
*Maintain perfusion (cerebral) | *Maintain perfusion (cerebral) | ||
** | **Treat [[hypotension]] | ||
** | **Ignore [[hypertension]] | ||
**normal PaCO2 (~40) | **Maintain normal PaCO2 (~40) | ||
* | *Target [[oxygen|normoxia]] | ||
**PaO2 80-120 | **PaO2 80-120 | ||
*[[Therapeutic Hypothermia]] | *[[Therapeutic Hypothermia]] | ||
*PCI | *PCI | ||
**Early reperfusion therapy is important to ID coronaries as ECG cannot reliably predict them in these cases<ref>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</ref> | **Early reperfusion therapy is important to ID coronaries as ECG cannot reliably predict them in these cases<ref>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</ref> | ||
*Aggressively treat hyperglycemia | **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 <ref>“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.</ref> | ||
** | *Aggressively treat [[hyperglycemia]] | ||
**No IV fluids with glucose | |||
**RISS | **RISS | ||
*Aggressive seizure treatment | *Aggressive [[seizure]] treatment | ||
** | **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> | |||
**If epileptiform activity present, treat as you would other patients with [[seizure]] | |||
*Minimize Irritation | *Minimize Irritation | ||
** | **[[Sedation|Sedatives]] +/- paralytics | ||
** | **Supine positioning | ||
==Prognostication<ref>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</ref>== | |||
*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 | |||
*Recommended to wait minimum of 72 hours post-ROSC for prognostication | |||
==See Also== | ==See Also== |
Latest revision as of 20:54, 27 February 2021
Management
- Maintain perfusion (cerebral)
- Treat hypotension
- Ignore hypertension
- Maintain normal PaCO2 (~40)
- Target normoxia
- PaO2 80-120
- Therapeutic Hypothermia
- PCI
- Aggressively treat hyperglycemia
- No IV fluids with glucose
- RISS
- Aggressive seizure treatment
- Minimize Irritation
- Sedatives +/- paralytics
- Supine positioning
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
- Recommended to wait minimum of 72 hours post-ROSC for prognostication
See Also
References
- ↑ 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
- ↑ “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.
- ↑ 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.
- ↑ 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