Post-Cardiac Arrest Care Algorithm
Note: This document provides a structured summary of the Post-Cardiac Arrest Care Algorithm for educational and reference purposes. It is not a substitute for certified ACLS training and adherence to the latest guidelines published by the American Heart Association (AHA) or other relevant governing bodies. Always consult the most current official guidelines.
1. ROSC Achieved
- **Confirm ROSC:** Return of pulse and blood pressure, sudden sustained increase in PETCO2 (typically $\ge$ 40 mmHg), spontaneous arterial pressure waves with intra-arterial monitoring.
- **Immediate Actions:** Begin post-cardiac arrest care.
2. Initial Stabilization & Assessment
- **Airway Management:** Manage airway (often requires advanced airway, confirm placement with waveform capnography).
- **Ventilation/Oxygenation:** Optimize ventilation and oxygenation (target O2 sat 92-98%, PaCO2 35-45 mmHg). Avoid hyperoxia and hypocapnia/hypercapnia.
- **Hemodynamic Support:** Manage hemodynamics to maintain adequate perfusion (target systolic BP > 90 mmHg or MAP > 65 mmHg). Use IV fluids and/or vasoactive medications (e.g., Norepinephrine, Dopamine) as needed.
- **Cardiac Assessment:** Obtain 12-lead ECG immediately.
- **Access:** Ensure reliable IV/IO access. Consider arterial line for continuous BP monitoring.
STEMI or High Suspicion?
Based on 12-lead ECG and clinical presentation.
YES – 3. If STEMI or high suspicion
- **Emergent Reperfusion:** Activate the cardiac catheterization lab for emergent coronary reperfusion (PCI).
- **Goal:** Door-to-balloon time for PCI < 90 minutes.
NO – 4. Assess Neurological Status
- Is the patient comatose (not obeying commands)?
- Consider emergent head CT to rule out intracranial pathology (e.g., hemorrhage) if not already done or clinically indicated.
Patient Comatose?
Is the patient not obeying commands?
YES – Initiate TTM
- Initiate targeted temperature management (TTM) to 32-36°C for at least 24 hours.
- Use a cooling device with feedback loop if available.
- Continuously monitor core temperature (esophageal, rectal, bladder).
NO – Continue Standard Care
Continue with standard post-cardiac arrest care and ongoing management.
5. Ongoing Management
- **Monitoring:** Continuous hemodynamic monitoring (arterial line, CVP), continuous ECG monitoring, consider continuous or intermittent EEG monitoring.
- **Respiratory Management:** Maintain normoxia, normocapnia. Provide lung-protective ventilation if intubated.
- **Glycemic Control:** Maintain euglycemia (target blood glucose 140-180 mg/dL).
- **Identify & Treat Causes:** Continue to search for and treat reversible causes (H’s and T’s).
- **Neurologic Prognostication:** Performed later, typically 72 hours after ROSC or rewarming, using multimodal approach (clinical exam, EEG, SSEP, imaging, biomarkers).
- **Advanced Critical Care:** Manage arrhythmias, electrolyte imbalances, infections, and other complications.
- **Consultations:** Consider neurology, cardiology, critical care consultations.
