Universal algorithm (according to the European Conference 2000)

Post Resuscitation Care

If a patient has a Return of Spontaneous Circulation (ROSC), start

Post-Resuscitation Care immediately. The initial PALS process is
intended to stabilize a patient during a life-threatening event. Post-
Resuscitation Care is meant to optimize ventilation and circulation,
preserve organ/tissue function, and maintain recommended blood
glucose levels. Below find a systematic approach followed by a post-
resuscitation care algorithm to guide you in your treatment.

RESPIRATORY SYSTEM

 Chest X-ray to verify ET tube placement

 Arterial blood gas (ABG) and correct acid/base disturbance
 Pulse oximetry (continuously monitor)
 Heart rate and rhythm (continuously monitor)
 End-tidal CO2 (if the patient is intubated)
 Maintain adequate oxygenation (saturation between 94% and 99%)
 Maintain adequate ventilation to achieve PCO2 between 35 to 45 mm
Hg unless otherwise indicated.
 Intubate if:
o Oxygen and other interventions do not achieve adequate oxygenation
o Needed to maintain a patent airway in the child with a decreased level
of consciousness
o Ventilation is not possible through non-invasive means, e.g.,
continuous positive airway pressure (CPAP)
 Control pain with analgesics and anxiety with sedatives (e.g.
benzodiazepines)
CARDIOVASCULAR SYSTEM

 Arterial blood gas (ABG) and correct acid/base disturbances

 Hemoglobin and hematocrit (transfuse or support as needed)
 Heart rate and rhythm (continuously monitor)
 Blood pressure (continuously monitor with arterial line)
 Central venous pressure (CVP)
 Urine output
 Chest X-ray
 12 lead ECG
 Consider echocardiography
 Maintain appropriate intravascular volume
 Treat hypotension (use vasopressors if needed and titrate blood
pressure)
 Pulse oximetry (continuously monitor)
 Maintain adequate oxygenation (saturation between 94% and 99%)
 Correct metabolic abnormalities (chemistry panel)
 NEUROLOGICAL SYSTEM
 Elevate head of bed if blood pressure can sustain cerebral perfusion
 Temperature
o Avoid hyperthermia and treat fever aggressively
o Do not re-warm hypothermic cardiac arrest victim unless hypothermia
is interfering with cardiovascular function
o Treat hypothermia complications as they arise
 Blood glucose
o Treat hypo/hyperglycemia (hypoglycemia defined as less than or
equal to 60 mg/dL)
 Monitor and treat seizures
o Seizure medications
o Remove metabolic/toxic causes
 Blood pressure (continuously monitor with arterial line)
 Maintain cardiac output and cerebral perfusion
 Normoventilation unless temporizing due to intracranial swelling
 Frequent neurological exams
 Consider CT and/or EEG
 Dilated unresponsive pupils, hypertension, bradycardia, respiratory
irregularities, or apnea may indicate cerebral herniation
RENAL SYSTEM

 Monitor urine output

o Infants and small children: > 1 mL/kg an hour
o Larger children: > 30mL an hour
o Exceedingly high urine output could indicate neurological or renal
problem (diabetes insipidus)
 Routine blood chemistries
 Arterial blood gas (ABG) and correct acid/base disturbances
 Urinalysis (when indicated)
 Maintain cardiac output and renal perfusion
 Consider the effect of medications on renal tissue (nephrotoxicity)
 Consider urine output in the context of fluid resuscitation
 Toxins can sometimes be removed with urgent/emergent
hemodialysis when antidotes fail or are not available
GASTROINTESTINAL SYSTEM

 Monitor nasogastric (NG)/orogastric (OG) tube for patency and

residuals
 Perform a thorough abdominal exam
o Tense abdomen may indicate bowel perforation or hemorrhage
 Consider abdominal ultrasound and/or abdominal CT
 Routine blood chemistries including liver panel
 Arterial blood gas (ABG) and correct acid/base disturbances
 Be vigilant for bleeding into the bowel, especially after hemorrhagic
shock
HEMATOLOGICAL SYSTEM

 Monitor complete blood count and coagulation panel

 Transfuse (as needed)
o Correct thrombocytopenia
o Fresh frozen plasma is to replenish clotting factors
o Consider calcium chloride or gluconate if massive transfusion
required
 Correct metabolic abnormalities (chemistry panel), especially after
transfusion
Pediatric Post-Resuscitation Care Algorithm