POST RESUSCITATION CARE

• 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