ACLS and ROSC in the ED: Talitha Cumi

Patients who cannot perform any purposeful movements on basic command meet indication for therapeutic hypothermia and targeted temperature management (TTM).

 Neuroprognostication after cardiac arrest

The TTM2 trial recently demonstrated that hypothermia at 33C following cardiac arrest was unhelpful. The study also showed that maintaining patients at a target temperature of 37.5 degrees is safe. Maintaining patients in a normothermic temperature range (e.g., 36-37.5 C) while minimizing paralytics and sedatives facilitates more accurate neuroprognostication. Much of the literature obtained over the past 15 years has been obfuscated by the use of hypothermia, paralytics, and high doses of sedatives. As hypothermia falls out of favor, we may notice that diagnostic tests start working better than previously.

 Post Cardiac Arrest Care

Once you achieve ROSC, your real work starts. Over 60% of patients with ROSC do not survive to hospital discharge. Our job is to optimize treatment and survival.

 Post-Cardiac Arrest Care

Unfortunately, more than two-thirds of those with ROSC will not leave the hospital alive. From optimizing tissue oxygen delivery to preventing hyperthermia, an in-depth look at the care of the post-arrest patient.

 Supportive management of the recently resuscitated patient

There is good evidence (discussed at length elsewhere) that mild therapeutic hypothermia or at least "temperature management) improves neurological recovery and mortality among comatose survivors of cardiac arrest. It is contraindicated for patients who are not comatose, and for patients in whom there is uncontrolled bleeding.

I’ve got a pulse… now what? – Post-Arrest Care in the Acute Setting

“I’ve got a pulse,” you hear the nurse shout. Finally, a sigh of relief comes over the crowded resuscitation room and you take a moment to reflect on what just happened… but, your work is just now about to truly begin. It is up to you to determine why the patient died in the first place and determine which crucial steps need to be initiated to increase your patient’s chance of survival.

Cardiac Arrest, E-CPR, & Post-Arrest Care with Dr. Jason Bartos

Based on this evidence, we know the likelihood of ROSC in the field drops significantly after 20-25 minutes. Thus, if the patient receives >3 shocks or >15-20 min of ongoing CPR without recovery of a perfusing rhythm, VA ECMO should be considered.

Immediate Post-ROSC Management

A team-based approach to the management of the post-ROSC (return of spontaneous circulation) patient focuses on initiation of therapeutic hypothermia, treatment of the underlying cause with transfer to the cath lab where appropriate, and management of the post-cardiac arrest syndrome.

Is a STEMI a STEMI in Post-ROSC Patients?

In this systematic review and meta-analysis of the diagnostic test accuracy of the post-ROSC EKG to predict acute coronary lesion or revascularization on coronary angiography in adults after cardiac arrest, ST elevation was found to more specific than sensitive test characteristics and all groups and subgroups.

Management of post-cardiac arrest syndrome

Although basic life support has been widely practiced to increase recovery from cardiac arrest, management of post-cardiac arrest patients have also made great progress.

Management of the Post-Cardiac Arrest Patient

Post cardiac arrest syndrome is a complicated compilation of maladaptive physiologic processes experienced after cardiac arrest.

Optimizing Post-Resuscitation Care in the Emergency Department: Addressing Post-Resuscitation Syndrome With a Structured Early Goal-Directed Approach

Worldwide survival rates from out-of-hospital cardiac arrest (OHCA) are low, despite great advances in resuscitation science research and technology. For reasons that are complex and multifactorial, many hospitals around the world do not provide systematic, structured post-resuscitation care, thereby contributing to the overall decreased survival rates.

Post Cardiac Arrest: Care of the ROSC Patient

Absent pupillary reflexes and absent motor response to pain are of no prognostic value soon after ROSC (but are of value at 72 hours).

Post ROSC Care

Caring for the post cardiac arrest patient is complex. Efforts to avoid re-arrest and best practices regarding ventilation, oxygenation, and neurocritical care should be provided...

The Post-ROSC Checklist: Standardizing Clinical Practices

Targeted Temperature Management (TTM) is currently recommended for all patients regardless of rhythm. The patient should be cooled to 32–36°C as soon as possible after ROSC using whatever technique is available in your institution, and kept cool for 24 hours.

Topics in Post-ROSC Care

Post-cardiac arrest patients are among the sickest groups of patients seen in the Emergency Department.