Difference between revisions of "Post cardiac arrest care"

(Source)
m (Rossdonaldson1 moved page Post cardiac arrest to Post cardiac arrest care)
 
(19 intermediate revisions by 8 users not shown)
Line 1: Line 1:
==Treatment==
+
==Management==
#Maintain perfusion (cerebral)
+
*Maintain perfusion (cerebral)
##Tx hypotension
+
**Treat [[hypotension]]
##ignore HTN
+
**Ignore [[hypertension]]
##normal PaCO2 (~40)
+
**Maintain normal PaCO2 (~40)
#Normoxia
+
*Target [[oxygen|normoxia]]
##PaO2 80-120
+
**PaO2 80-120
#Mild Hypothermia (except in trauma)
+
*[[Therapeutic Hypothermia]]
##32-34 deg C for 12-24 hrs
+
*PCI
##aggresivly Tx hyperthermia (acetamin)
+
**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>
##prevent shivering (meperidine, buspirone, and/or dexmetomidine)
+
**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 Tx hyperglycemia
+
*Aggressively treat [[hyperglycemia]]
##no IVFs with glucose
+
**No IV fluids with glucose
##RISS
+
**RISS
#Aggressive Seizure Tx
+
*Aggressive [[seizure]] treatment
##prophylaxis unproven
+
**Prophylaxis unproven
#Minimize Irritation
+
**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>
##sedatives +/- paralytics
+
**If epileptiform activity present, treat as you would other patients with [[seizure]]
##supine flat
+
*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==
Line 23: Line 32:
 
*[[Adult Cardiac Arrest]]
 
*[[Adult Cardiac Arrest]]
  
==Source==
+
==References==
2/17/06  DONALDSON (adapted from Rosen)
+
<references/>
  
[[Category:Cards]]
+
[[Category:Cardiology]]

Latest revision as of 20:54, 27 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
  • Recommended to wait minimum of 72 hours post-ROSC for prognostication

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