Describe the initial stabilization.
Airway: Secure the airway in comatose patients with early placement of an endotracheal tube.
Target respiratory parameters: Titrate FiO2 and initiate waveform capnography.
Respiratory rate: Start at 10 breaths/minute.
Titrate oxygen therapy to reach SpO2 of 92–98% and PaCO2 of 35–45 mm Hg.
Target hemodynamic parameters: Administer IV fluids as needed and consider vasopressors and/or inotropes.
Systolic blood pressure > 90 mm Hg
Mean arterial pressure > 65 mm Hg
Obtain 12-lead ECG: to elevate for acute ST-segment elevation
Describe additional management and urgent interventions.
Address the cause of arrest:
Start targeted temperature management (TTM): Aim for a body temperature of 32–36°C for at least 24 hours
Initiate other neuroprotective measures
Admit to ICU: for further management and neuroprognostication
Don't forget the ABCs of postresuscitation care: Obtain an ABG, BP, and Chest x-ray, Draw blood for laboratory studies, and ensure an ECG is performed. Talk to the Family, Give thanks to the team, consider initiation of Hypothermia, and admit to ICU.
Describe hte neuroprognostication.
Neuroprognostication after cardiac arrest is complex and should be conducted by specialists.
The extent of irreversible loss of brain function can be estimated clinically (e.g., neurological examination, apnea testing) and using ancillary brain death tests (e.g., EEG).
Brain death assessment is typically carried out 72 hours after cardiac arrest or cessation of TTM.
Describe organ donation.
Consider organ donation for all patients with ROSC in whom brain death is declared.
If ROSC does not occur, kidney and liver donation may still be possible, depending on the center.
See “Organ and tissue donation” for related clinical, systemic, legal, and ethical issues.
Last changed2 years ago