Depending on the circumstances surrounding a cardiac arrest, a significant number of the survivors get a favorable recovery. However, some victims suffer multiple organ damage even after a full-fledged recovery. For this reason, cardiac arrest care practitioners are working concurrently with hospitals, emergency medical services, and the community to ensure quality care for cardiac arrest patients. Immediate post-cardiac arrest care algorithm provides key guidelines for stabilizing the patient, optimizing neurological and cardiovascular function, and preventing further complications. This blog discusses the essential guidelines for post-cardiac arrest care to improve survival outcomes.
Key guidelines for post-cardiac arrest care
The immediate post-cardiac care algorithm is a standardized approach used for managing cardiac arrest patients after the Return of Spontaneous Circulation (ROSC). The post-cardiac arrest protocol guides you to optimize respiratory function, neurological status, and hemodynamics while preventing cardiac arrest recurrence. Below is a comprehensive breakdown of the immediate post-cardiac arrest care algorithm:
Optimize oxygenation and ventilation:
Airway management and ventilation are critical components of cardiopulmonary resuscitation as they enhance oxygen delivery. The immediate post-cardiac care algorithm emphasizes optimized oxygenation and ventilation to prevent hypoxic injury and increase the patient’s chances of survival. To achieve this, consider these two steps:
- Maintain oxygen saturation (SpO2): You should keep the oxygen saturation between 94% and 99%. This ensures that the patient has sufficient tissue oxygenation and does not get hypoxia, which is harmful to their survival.
- Ensure adequate ventilation: Following ROSC, ensure you provide enough ventilation. To achieve this, maintain PaCO2 within a range of 35-45 mm Hg. Avoid hyperventilation, which can lead to reduced cerebral blood flow or hypocapnia.
Hemodynamic support:
The immediate post-cardiac care algorithm uses hemodynamic support as a standard practice after a cardiac arrest. You must consider hemodynamic support as it assists in maintaining systemic perfusion with the correct cardiac output. As a result, this prevents heart overload or failure. For hemodynamic support, consider these steps:
- Maintaining blood pressure: To maintain blood pressure after cardiac arrest, ensure the systolic blood pressure (SBP) is equal to or greater than 90 mm HG or the mean arterial pressure (MAP) is equal to or greater than 65 mm Hg. These parameters are crucial for maintaining adequate organ perfusion.
- Fluid and medication administration: To maintain the patient’s blood pressure and volume, you need to administer intravenous fluids. Also, consider using vasopressors like norepinephrine and inotropes such as dobutamine if there is a need to support blood pressure and heart function.
Perform a 12-lead ECG:
As soon as the patient gets a return of spontaneous circulation (ROSC), it is important to perform a 12-Lead ECG. This test is important as it identifies if a patient requires immediate invasive coronary angiography. The immediate post-cardiac care algorithm guidelines suggest the need to:
- Identify cardiac issues: You need to perform a 12-lead ECT. This test will detect ST-segment elevation myocardial infarction (STEMI) or other critical arrhythmias.
- Coronary reperfusion: If you suspect acute coronary syndrome (ACS) or STEMI, consider providing immediate coronary reperfusion therapies, including percutaneous coronary intervention (PCI). PCI is useful for restoring blood flow to the patient’s heart.
- Address hypothermia: If the patient’s heart restarts after a cardiac arrest, it is important to consider therapeutic hypothermia. You can do this using Targeted Temperature Management (TTM) where you regulate temperature after a cardiac arrest. For unconscious patients who get the Return of Spontaneous Circulation (ROSC). Ensure the temperature remains 32-36°C. Addressing hypothermia improves neurological outcomes by reducing metabolic demand and preventing further damage to the patient’s brain.
Advanced critical care:
According to the immediate post-cardiac care algorithm, you must provide advanced critical care to a cardiac arrest patient to influence their neurological outcome and enhance their chances of survival. As part of advanced critical care:
- Transfer the patient to intensive care: Transfer the patient to an intensive care unit (ICU) to ensure advanced support through close and continuous monitoring.
- Monitor and manage metabolic and neurological status: Ensure you monitor the patient’s blood glucose level while you manage either hypoglycemia or hyperglycemia. Monitor if the patient has seizures and offer treatment to avoid more damage. During advanced critical care, also evaluate and treat the patient for other potential causes that may trigger cardiac arrest, including electrolyte imbalance and toxins.
- Neurological assessment: Cardiac arrest may lead to neurological damage. To improve a patient's condition, you must provide a neurological assessment. This can be done by:
- Conducting regular neurological checks: Continuously assess the patient’s neurological function and note any changes or improvements manifested by the patient.
- Deferring prognostication: You need to delay definitive prognostication until 72 hours after the patient has returned. Consider rewarming if you applied Targeted Temperature Management for hypothermia.
Conclusion
The immediate post-arrest care algorithm is an important protocol as it emphasizes on key interventions to improve patient outcomes after a cardiac arrest. You must use the algorithm as it will guide you to provide post-cardiac care based on the patient’s case and the available resources. Since there is a possibility of recurrence, you need to ensure immediate care after cardiac arrest. The actions you will take as guided by the algorithm will assist in stabilizing the patient, preventing cardiac arrest recurrence, and optimizing the patient’s condition.
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