POST CARDIAC ARREST CARE

Alcala Althea D. - BSN 4A

A major component of advanced life support is post cardiac arrest care. The majority of fatalities occur
during the first 24 hours of cardiac arrest. (AHA 2010)

Post cardiac arrest care has the potential to significantly reduce early mortality due to hemodynamic
instability as well as later morbidity and death due to multiorgan failure and brain damage.

Post Cardiac Arrest Care Algorithm is as follows:

➔ First is to verify Return of Spontaneous Circulation (ROSC). When circulation persists and cardiac
resuscitation has stopped for at least 20 minutes, someone is said to have maintained
restoration of spontaneous circulation. Cardiopulmonary resuscitation and defibrillation can be
used to restore spontaneous circulation.

➔ Second is to maintain a patent airway. Consider or include endotracheal tubing and provide 10
breaths per minute. An ETT can help in keeping the airway open in order to give oxygen,
medicine, or anesthesia, it also supports breathing.

➔ Next is to titrate the oxygen to maintain a PETCO2 of 35-40 mm Hg using a quantitative

waveform capnography. Waveform capnography is the continuous quantitative measurement of
exhaled carbon dioxide. (CO2 ). CO2 concentration is displayed graphically as a capnogram
(waveform) representing CO2. If there is no access to a waveform capnography machine, titrate
the oxygen to keep the oxygen saturation 92% to 98%

➔ Proceed to securing an IV line for administration of medications. Maintain systolic blood

pressure above 90 mm Hg and/or mean arterial pressure above 65 mm Hg. I f the patient has a
low blood pressure you can consider either or all of the following:
- Giving 1 to 2 liters of saline or Ringer’s lactate IV fluid
- Starting an epinephrine IV or a dopamine IV infusion
- For extremely low systolic blood pressure, consider giving norepinephrine
- Consider norepinephrine for extremely low systolic blood pressure.
(Depend on what the physician has ordered)

➔ Rule out myocardial infarction through obtaining a 12-lead ECG. If MI is suspected, a

percutaneous coronary intervention (PCI) is considered which uses a catheter (a thin flexible
tube) to place a small structure called a stent to open up blood vessels in the heart that have
been narrowed.

➔ Next is to determine if the patient is comatose.

◆ If the patient is in comatose:
● Keep the body temp 32-36°C for 24 hours initially (Target temperature).
● Obtain an EEG monitoring to rule out nonconvulsive seizures and to give
anticonvulsants if seizure is present
 ● Obtain head CT to assess cerebral edema which is common in comatose patient,
post cardiac arrest
● Maintain oxygen, glucose, carbon dioxide, etc.to maintain adequate oxygenation
and minimize fraction of inspired oxygenation
● Avoid barotrauma which is an injury to the body because of changes in
barometric (air) or water pressure.
◆ If the patient is awake:
● Maintain oxygen, glucose, carbon dioxide, etc.
● Avoid barotrauma

It is also possible to perform the following:

Therapeutic Hypothermia
● Recommended for comatose individuals with the return of spontaneous circulation after a
cardiac arrest event.
● Individuals should be cooled to 89.6 to 93.2 degrees F (32 to 36 degrees C) for at least 24 hours.

Neurologic Care
● Neurologic assessment is key, especially when withdrawing care (i.e., brain death) to decrease
false-positive rates. Specialty consultation should be obtained to monitor neurologic signs and
symptoms throughout the post-resuscitation period.

Use of Vasoactive Drugs After Cardiac Arrest

● Vasoactive drugs may be administered after ROSC to support cardiac output, especially blood
flow to the heart and brain. Drugs may be selected to improve heart rate (chronotropic effects),
myocardial contractility (inotropic effects), or arterial pressure (vasoconstrictive effects), or to
reduce afterload (vasodilator effects)
● Common Vasoactive drugs include Epinephrine, Norepinephrine, Phenylephrine Dopamine,
Dobutamine, Milrinone