Post cardiac arrest care

Management

Maintain perfusion (cerebral)
- Treat hypotension
- Ignore hypertension
- Maintain normal PaCO2 (~40)
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
- Sedatives +/- paralytics
- Supine positioning

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

↑ 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

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