• Oxygenation : Maintain SpO2 >94%

  • Perfusion: Capnography can be used as a guide. Target PETCO2 35-40mm Hg
  • BP maintenance:
    • 1-2 L Normal Saline or Ringer Lactate. Do not give hypotonic fluids
    • SBP must be kept >90, and MBP > 65
    • Dopamine 2-10 microgram / kg /minute
    • Norepinephrine 0.1-0.5 micrograms/kg/minute
    • Epinephrine 0.1-0.5 micrograms /kg/ minute
  • Hypothermia: Maintain 32-34 degree C
    • Use bladder or esophageal thermometers
  • 12 Lead EKG
    • The reason the most common cause of arrest is MI
    • Look for new ST elevation or new LBBB, assess QTc
    • Concurrent PCI and hypothermia are safe
    • Coma is not a contraindication to cardiac intervention
    • If STEMI noted , or if there is a high index of suspicion for AMI, take to cath suite.
  • Continuous cardiac monitoring
    • Treat arrhythmias as they happen instead of prophylaxis
  • Echocardiogram to look for myocardial stunning
    • May need Dobutamine 5-10 micrograms /kg/minute
  • Remove reversible causes
  • Endovascular or surface cooling 32 degrees to 34 degrees C for 24h.
    • After 24 h slow rewarming at 0.25 deg C per hour
  • Neuro: serial neuro checks
  • EEG monitoring if comatose
  • Watch for hypokalemia and correct if needed
  • Monitor urine output, maintain euvolemia
  • Treat hypoglycemia if <80mg/dl

  • Treat Hyperglycemia if >180mg/dl

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