Post-cardiac arrest care | ACLS-Algorithms.com

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  1. Lori says

    I work in an an ICU that is not currently doing TTM for post cardiac arrest patients. I’m not sure why we don’t but I’m trying to help. Can you point me to literature to help me share with the hospital why we need to start doing this? I know it preserves brain function, etc. Also one of our supervisors said that TTM would be contraindicated in a post cardiac arrest patient who was septic. Is this correct? I’ve never heard of a distinction like that so I wanted to check.

    Thank you so much!
    Lori

    • ACLS says

      Thank you for the question about targeted temperature management. The link below is to the definitive reference from the circulation journal regarding targeted temperature management. There are reference links too much of the literature regarding this subject. I think you’ll find this the best reference. Circulation Journal Article

      Kind regards,
      Jeff

    • ACLS says

      The American Heart Association does not provide specific details with regard to infusion rate for The administration of ice called isotonic fluids for targeted temperature management. In their literature it states “rapid iv infusion.”

      This would implies that the infusion of fluid should be rapidly infused but slower than a bolus I would assume that the 1 L infusion would be administered in no more than one hour and preferably in under 15 minutes.

      Kind regards,
      Jeff

  2. Ela Kowalski says

    Can we use Sequential Compression Device (SCD) as an adjunct to pharmacological DVT prophylaxis while patient is undergoing TTM? Or should we rely only on Pharmacological DVT prophylaxis?

    • ACLS says

      If you are referring strictly to DVT prophylaxis then SCD therapy would be just as efficient as pharmacological DVT prophylaxis. If you are including thrombus prevention related to prevention of MI then you need to rely on pharmacological prophylaxis.

      Kind regards,
      Jeff

  3. Amanda says

    Is there a time set for how long we should wait to make sure we truly have ROSC? Or is it we have capnogrophy and pulse and we automatically go to the post ROSC care algorithm right away.

    • ACLS says

      If you are at the step of a rhythm/pulse check and you establish that the pulse is present then you will begin the post cardiac arrest care algorithm.

      The same is true with regard to capnography. If you are providing CPR for 2 minutes and you see the ETCO2 rise to 35-45 mmHg then you would initiate the post-cardiac arrest care algorithm at the end of the 2 minute cycle of CPR.

      Kind regards,
      Jeff

  4. Mustafa says

    Hi Jeff
    If patient developed cardiac arrest, it is important to give him IVF N.S running drop during resuscitation …

    2. 2nd rescue arrived with AED , It is necessary to 1st rescu to complete 2 mit of cycle CPR and handover AED to 1st rescue or no need to complete 2 mit of CPR immediately handover AED to 1st resuc

    • ACLS says

      1. Having a running IV fluid drip of NS Is convenient but not necessary. You just need to ensure that all medications are followed with a 20 mL rapid IV push of NS.

      2. This depends upon the situation. If this was a witnessed arrest then once the AED arrives, CPR can be immediately stopped to attach the AED and analyze the rhythm.

      If this was a unwitnessed arrest then once the AED arrives, the two minutes of CPR should be completed and then the AED attached in the rhythm and analyzed.

      Kind regards,
      Jeff

  5. alexander vinckenbosch says

    Also verry important is to Ensure your patiënt head would be in a 30° angle due to the fact that a elevation of the head could help to fight a increase in ICP.

    • Jeff with admin. says

      I do not have a specific opinion about this subject as I do not have any experience with use of routine steroid administration during the post cardiac arrest phase.

      I can refer you to a recently published article found in the link below.
      The article seems to indicate that routine steroid use may slightly improve outcomes, but more research is needed.

      Post-Cardiac Arrest Steroid Use

      Kind regards,
      Jeff

  6. Kelli S. says

    In the setting of Out of Hospital Cardiac Arrest (OHCA) is there a recommended time frame before initiating transport post ROSC? Is there a greater risk of re-arrest moving the patient too quickly?

    • Jeff with admin. says

      Immediate transport to a higher level of care in post-arrest after ROSC is recommended. As far as I know, there is not an increased risk of rearrest during transport.

      Early access to PCI is of great importance and this would demand rapid transport.

      Overall, early access to a higher level of care for PCI and neurological intensive care is desired after ROSC. The earlier the post-arrest interventions are implemented the better the outcomes.

      As a caveat, there is literature that indicates that CPR performed during transport may decrease ROSC due to poor quality of cpr performed. In other words, it appears that is is better to obtain ROSC and then transport.

      Kind regards,
      Jeff

      • Mark E Vanmaren says

        Kelli (and Jeff),

        EMS protocols in my region specify that after ROSC is obtained the pt should be observed but not moved for 10 minutes. During this time there is certainly plenty to do: obtain blood pressure, 12L EKG, any appropriate blood tests, consult with family, hang a vasopresser drip, arrange for a crew of responders to accompany in the rig in case of re-arrest, get the means of moving the pt in place (backboard, Megamover, etc).
        We have found that if we move the pt too soon re-arrest goes undetected for a bit due to us having the patient in a stairwell,a side yard, or out in the rain, etc, where no one is able to closely monitor status.
        If re-arrest occurs in a moving rig we pull over to perform CPR unless the ER can be reach in a couple of minutes. CPR quality and responder safety are at risk to do otherwise.

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