Once ROSC is obtained, treatment moves from the cardiac arrest algorithm to the evaluate, identify, intervene sequence of the systematic approach algorithm.
During the post-cardiac arrest phase, a systems approach is used to support and maintain the stability of the patient.
The objective is to reduce morbidity and mortality through the assessment and management of the respiratory system, the cardiovascular system, and the neurologic system.
Each system is assessed and managed to ensure optimization of oxygenation, ventilation, and perfusion. These actions are carried out in order to stabilize cardiopulmonary function, and preserve neurologic function.
Open the systematic approach algorithm diagram to visualize this movement from the cardiac arrest algorithm to the systematic approach algorithm. PALS Systematic Approach Algorithm diagram
Goals for Post-Cardiac Arrest:
The goals for the post cardiac arrest phase center around the identification and treatment of organ system dysfunction.
- Optimize and stabilize airway, oxygenation, and ventilation
- Confirm proper ET tube placement
- Provide adequate oxygenation and ventilation
- Monitor end-tidal CO2 (Capnography), evaluate blood gas, chest x-ray
- Support tissue perfusion and cardiovascular function
- Prevent shock
- Maintain adequate blood pressure and perfusion
- Treat arrhythmias
- Assess tissue perfusion by monitoring lactate concentration, venous oxygen saturation, and base deficit
- Hemodynamic monitoring of intra-arterial blood pressure
- Urine output, capillary refill, skin temperature
- Neurologically intact survival
- Implement TTM (targeted temperature management)
- Avoid hyperthermia
- Adequate analgesia and sedation
- Treat seizures and increased intracranial pressure
- Avoid hyperventilation
- Monitor core temperature
- Point of care blood glucose level
- Perform ongoing neurological assessments