Post-Resuscitation Care

Introduction

Surviving cardiac arrest is only the first step in a patient’s journey. Proper post-resuscitation care is essential to prevent further complications, optimize neurological recovery, and improve survival rates. This care follows return of spontaneous circulation (ROSC) and involves a multidisciplinary approach.

Key Components of Post-Resuscitation Care

1. Hemodynamic Stabilization

  • Maintain adequate blood pressure (target: MAP ≥ 65 mmHg).
  • Use fluids, vasopressors, and inotropes as needed.
  • Monitor for arrhythmias and manage promptly.

2. Targeted Temperature Management (TTM)

  • Helps improve neurological outcomes by reducing brain injury.
  • Target temperature: 32-36°C for at least 24 hours.
  • Avoid fever (>37.5°C) after TTM.

3. Neurological Monitoring and Prognostication

  • Frequent clinical exams (pupillary response, motor response).
  • EEG monitoring for seizure detection.
  • Neuroimaging (CT/MRI) if indicated.

4. Oxygenation and Ventilation

  • Target SaO₂ of 94-98% (avoid hyperoxia).
  • Maintain normal CO₂ levels (PaCO₂ 35-45 mmHg).

5. Cardiac Support and Investigations

  • Perform ECG to detect myocardial infarction.
  • Consider coronary angiography in suspected cardiac causes.
  • Evaluate for heart failure or cardiomyopathy.

6. Infection Management

  • Monitor for pneumonia or sepsis.
  • Use appropriate antibiotics if infection is suspected.

7. Long-Term Rehabilitation and Psychological Support

  • Address cognitive and emotional recovery.
  • Provide physical therapy and rehabilitation.
  • Family education and counseling.

Conclusion

Post-resuscitation care is critical for long-term survival and quality of life. A structured approach covering hemodynamic management, neurological assessment, oxygenation, cardiac support, and rehabilitation can significantly improve patient outcomes.

Source recommendations

1. European Resuscitation Council Guidelines for Post-Resuscitation Care

  1. https://pubmed.ncbi.nlm.nih.gov/33765189/
  2. https://cprguidelines.eu/assets/guidelines/European-Resuscitation-Council-and-European-Societ.pdf
  3. https://pubmed.ncbi.nlm.nih.gov/26464394/
  4. https://pmc.ncbi.nlm.nih.gov/articles/PMC7993077/
  5. https://www.sciencedirect.com/science/article/abs/pii/S0300957221000654

2. American Heart Association Guidelines for Post-Cardiac Arrest Care

  1. https://www.ahajournals.org/doi/10.1161/CIR.0000000000001194
  2. https://cpr.heart.org/-/media/CPR-Files/CPR-Guidelines-Files/Algorithms/AlgorithmACLS_PCAC_200622.pdf?sc_lang=en
  3. https://www.ahajournals.org/doi/10.1161/CIR.0000000000001163
  4. https://cpr.heart.org/en/resuscitation-science/cpr-and-ecc-guidelines/algorithms
  5. https://pubmed.ncbi.nlm.nih.gov/20956225/

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