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Introduction
- Systematic post-resuscitation care after return of spontaneous circulation (ROSC) can improve the likelihood of patient survival with good neurological function and quality of life.
Clinical Presentation
- Patients with a return of spontaneous circulation following cardiac arrest.
Exclusion Criteria
Exclusion Criteria
Risk Assessment
- The focus of post resuscitation care is on ensuring adequate cerebral perfusion, oxygenation and supportive treatment to allow the recovery of vital organs.
- Continue to work as a team.
- Anticipate re-arrest and plan accordingly.
- Unless there are compelling reasons to move immediately, DO NOT Rush.
- ROSC patients are often unstable initially. Time should be taken to plan patient packaging, handling and subsequent egress whilst they stabilise and build up blood pressure. Rough manual handling / jolting of the patient is undesirable. Use this time to ensure IV lines are secure, and acquire 12 Lead ECG’s.
- Cooling in the prehospital phase is controversial and is a longer term strategy in general. Tympanic temps can be unreliable. The unconscious patient can be blanketed and NO patient should be allowed to shiver.
- Recovery of infants and children is typically slower than adults as cardiac arrest is usually secondary to prolonged hypoxaemia.
Management
Primary Care
- Re-evaluate Primary Survey
- Re-evaluate oxygenation and ventilation
- Provide supportive ventilation if required
- Start at age appropriate ventilation rate as necessary; try not to exceed rate indicated as per Clinical Skill
- Avoid trying to correct abnormally high EtCO2 in the first few minutes.
- Titrate oxygen delivery as required, aiming for SpO2 between 94 - 98%.
- Avoid hyperventilation / hyperinflation (as this can impede venous return and stimulate a vagal response, inhibiting the effective rise of mean arterial pressure)
- Provide supportive ventilation if required
- Vital Sign Survey
- Monitor patient persistently, recording full observations every 5 minutes
- Transport Priority 1, pre-notifying receiving facility
Intermediate Care (EMT / Level 2)
- As per Primary Care guidelines
Advanced Care (AP)
- Consider and address precipitating causes of arrest
- Perform serial 12-lead ECG’s, as reperfusion rhythms may not be of diagnostic quality
- Follow STEMI pathway if indicated
- Manage hypotension if BP is slow to rise:
- Administer Intravenous Crystalloid Solutions (Normal Saline)
- If remaining hypotensive post IV/IO fluid administration, administer Adrenaline.
- Administer Intravenous Crystalloid Solutions (Normal Saline)
- Avoid hypoglycaemia; be aware that blood glucose readings may be inaccurate if peripheries are still poorly perfused. Apply judgement before opting to administer IV glucose.
- Consider Naloxone
- Only once circulation is restored
- Only if there is a strong suspicion that the arrest was caused by opiate/opioid overdose
- Monitor patient persistently, recording full observations every 5 minutes
- Transport Priority 1 to appropriate destination, pre-notifying receiving facility
Critical & Extended Care (CCP, PSO)
- As per Advanced Care (AP) guidelines
Additional Information
- N/A
References
References
Document Control
Directorate
Clinical Services
Responsible Manager
Head of Clinical Services
Published Date
Review Date
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