Post Resuscitation Care. To understand: The need for continued resuscitation after return of...
-
Upload
rodney-chapman -
Category
Documents
-
view
227 -
download
1
Transcript of Post Resuscitation Care. To understand: The need for continued resuscitation after return of...
![Page 1: Post Resuscitation Care. To understand: The need for continued resuscitation after return of spontaneous circulation How to treat the post cardiac arrest.](https://reader035.fdocuments.us/reader035/viewer/2022062409/5697bfa81a28abf838c9960e/html5/thumbnails/1.jpg)
Post Resuscitation Care
![Page 2: Post Resuscitation Care. To understand: The need for continued resuscitation after return of spontaneous circulation How to treat the post cardiac arrest.](https://reader035.fdocuments.us/reader035/viewer/2022062409/5697bfa81a28abf838c9960e/html5/thumbnails/2.jpg)
To understand:
• The need for continued resuscitation after return of spontaneous circulation
• How to treat the post cardiac arrest syndrome
• How to transfer the patient safely
• The role and limitations of assessing prognosis after cardiac arrest
Learning outcomes
![Page 3: Post Resuscitation Care. To understand: The need for continued resuscitation after return of spontaneous circulation How to treat the post cardiac arrest.](https://reader035.fdocuments.us/reader035/viewer/2022062409/5697bfa81a28abf838c9960e/html5/thumbnails/3.jpg)
Chain of Survival
![Page 4: Post Resuscitation Care. To understand: The need for continued resuscitation after return of spontaneous circulation How to treat the post cardiac arrest.](https://reader035.fdocuments.us/reader035/viewer/2022062409/5697bfa81a28abf838c9960e/html5/thumbnails/4.jpg)
Post resuscitation care
The goal is to restore:
• Normal cerebral function
• Stable cardiac rhythm
• Adequate organ perfusion
• Quality of life
![Page 5: Post Resuscitation Care. To understand: The need for continued resuscitation after return of spontaneous circulation How to treat the post cardiac arrest.](https://reader035.fdocuments.us/reader035/viewer/2022062409/5697bfa81a28abf838c9960e/html5/thumbnails/5.jpg)
Post cardiac arrest syndrome
• Post cardiac arrest brain injury:• Coma, seizures, myoclonus
• Post cardiac arrest myocardial dysfunction
• Systemic ischaemia-reperfusion response• ‘Sepsis-like’ syndrome
• Persistence of precipitating pathology
![Page 6: Post Resuscitation Care. To understand: The need for continued resuscitation after return of spontaneous circulation How to treat the post cardiac arrest.](https://reader035.fdocuments.us/reader035/viewer/2022062409/5697bfa81a28abf838c9960e/html5/thumbnails/6.jpg)
Airway and breathing
• Ensure a clear airway, adequate oxygenation and ventilation
• Consider tracheal intubation, sedation and controlled ventilation
• Pulse oximetry: • Aim for SpO2 94 – 98%
• Capnography:• Aim for normocapnia• Avoid hyperventilation
![Page 7: Post Resuscitation Care. To understand: The need for continued resuscitation after return of spontaneous circulation How to treat the post cardiac arrest.](https://reader035.fdocuments.us/reader035/viewer/2022062409/5697bfa81a28abf838c9960e/html5/thumbnails/7.jpg)
Airway and breathing
• Look, listen and feel
• Consider:• Simple/tension pneumothorax• Collapse/consolidation• Bronchial intubation• Pulmonary oedema• Aspiration• Fractured ribs/flail segment
![Page 8: Post Resuscitation Care. To understand: The need for continued resuscitation after return of spontaneous circulation How to treat the post cardiac arrest.](https://reader035.fdocuments.us/reader035/viewer/2022062409/5697bfa81a28abf838c9960e/html5/thumbnails/8.jpg)
Airway and breathing
• Insert gastric tube to decompress stomach and improve lung compliance
• Secure airway for transfer
• Consider immediate extubation if patient breathing and conscious level improves quickly after ROSC
![Page 9: Post Resuscitation Care. To understand: The need for continued resuscitation after return of spontaneous circulation How to treat the post cardiac arrest.](https://reader035.fdocuments.us/reader035/viewer/2022062409/5697bfa81a28abf838c9960e/html5/thumbnails/9.jpg)
Circulation
• Pulse and blood pressure
• Peripheral perfusion e.g. capillary refill time
• Right ventricular failure• Distended neck veins
• Left ventricular failure• Pulmonary oedema
• ECG monitor and 12-lead ECG
![Page 10: Post Resuscitation Care. To understand: The need for continued resuscitation after return of spontaneous circulation How to treat the post cardiac arrest.](https://reader035.fdocuments.us/reader035/viewer/2022062409/5697bfa81a28abf838c9960e/html5/thumbnails/10.jpg)
Disability
Neurological assessment:
• Glasgow Coma Scale score
• Pupils
• Limb tone and movement
• Posture
![Page 11: Post Resuscitation Care. To understand: The need for continued resuscitation after return of spontaneous circulation How to treat the post cardiac arrest.](https://reader035.fdocuments.us/reader035/viewer/2022062409/5697bfa81a28abf838c9960e/html5/thumbnails/11.jpg)
Glasgow Coma Scale scoreGlasgow Coma Scale score (GCS 3 – 15)
Eyes (4) Verbal (5) Motor (6)
6 Obeys commands
5 Orientated Localises
4 Spontaneously Confused Normal flexion
3 To speech Inappropriate words Abnormal flexion
2 To pain Incomprehensible sounds Extension
1 Nil Nil Nil
![Page 12: Post Resuscitation Care. To understand: The need for continued resuscitation after return of spontaneous circulation How to treat the post cardiac arrest.](https://reader035.fdocuments.us/reader035/viewer/2022062409/5697bfa81a28abf838c9960e/html5/thumbnails/12.jpg)
Further assessment History
• Health before the cardiac arrest
• Time delay before resuscitation
• Duration of resuscitation
• Cause of the cardiac arrest
• Family history
![Page 13: Post Resuscitation Care. To understand: The need for continued resuscitation after return of spontaneous circulation How to treat the post cardiac arrest.](https://reader035.fdocuments.us/reader035/viewer/2022062409/5697bfa81a28abf838c9960e/html5/thumbnails/13.jpg)
Further assessment Monitoring
• Vital signs• ECG• Pulse oximetry• Blood pressure e.g. arterial line• Capnography• Urine output• Temperature
![Page 14: Post Resuscitation Care. To understand: The need for continued resuscitation after return of spontaneous circulation How to treat the post cardiac arrest.](https://reader035.fdocuments.us/reader035/viewer/2022062409/5697bfa81a28abf838c9960e/html5/thumbnails/14.jpg)
Further assessment Investigations
• Arterial blood gases • Full blood count• Biochemistry including blood glucose• Troponin• Repeat 12-lead ECG • Chest X-ray• Echocardiography
![Page 15: Post Resuscitation Care. To understand: The need for continued resuscitation after return of spontaneous circulation How to treat the post cardiac arrest.](https://reader035.fdocuments.us/reader035/viewer/2022062409/5697bfa81a28abf838c9960e/html5/thumbnails/15.jpg)
Chest X-ray
![Page 16: Post Resuscitation Care. To understand: The need for continued resuscitation after return of spontaneous circulation How to treat the post cardiac arrest.](https://reader035.fdocuments.us/reader035/viewer/2022062409/5697bfa81a28abf838c9960e/html5/thumbnails/16.jpg)
Transfer of the patient
• Discuss with admitting team• Cannulae, drains, tubes secured• Suction• Oxygen supply• Monitoring• Documentation• Reassess before leaving• Talk to family
![Page 17: Post Resuscitation Care. To understand: The need for continued resuscitation after return of spontaneous circulation How to treat the post cardiac arrest.](https://reader035.fdocuments.us/reader035/viewer/2022062409/5697bfa81a28abf838c9960e/html5/thumbnails/17.jpg)
Out-of-hospital VF arrest associated with AMI
Pacing
Cooling
IABP
Defibrillator
Inotropes
Ventilation
Enteral nutrition
Insulin
![Page 18: Post Resuscitation Care. To understand: The need for continued resuscitation after return of spontaneous circulation How to treat the post cardiac arrest.](https://reader035.fdocuments.us/reader035/viewer/2022062409/5697bfa81a28abf838c9960e/html5/thumbnails/18.jpg)
Optimising organ functionHeart
• Post cardiac arrest syndrome
• Ischaemia-reperfusion injury:• Reversible myocardial dysfunction for 2-3 days• Arrhythmias
![Page 19: Post Resuscitation Care. To understand: The need for continued resuscitation after return of spontaneous circulation How to treat the post cardiac arrest.](https://reader035.fdocuments.us/reader035/viewer/2022062409/5697bfa81a28abf838c9960e/html5/thumbnails/19.jpg)
Optimising organ functionHeart
• Poor myocardial function despite optimal filling:• Echocardiography• Cardiac output monitoring• Inotropes and/or balloon pump
• Mean blood pressure to achieve: • Urine output of 1 ml kg-1 hr-1 • Normalising lactate concentration
![Page 20: Post Resuscitation Care. To understand: The need for continued resuscitation after return of spontaneous circulation How to treat the post cardiac arrest.](https://reader035.fdocuments.us/reader035/viewer/2022062409/5697bfa81a28abf838c9960e/html5/thumbnails/20.jpg)
Optimising organ functionBrain
• Impaired cerebral autoregulation – maintain ‘normal’ blood pressure
• Sedation• Control seizures• Glucose (4-10 mmol l-1)• Normocapnia• Avoid/treat hyperthermia• Consider therapeutic hypothermia
![Page 21: Post Resuscitation Care. To understand: The need for continued resuscitation after return of spontaneous circulation How to treat the post cardiac arrest.](https://reader035.fdocuments.us/reader035/viewer/2022062409/5697bfa81a28abf838c9960e/html5/thumbnails/21.jpg)
Therapeutic hypothermiaWho to cool?
• Unconscious adults with ROSC after VF arrest should be cooled to 32-34oC
• May benefit patients after non-shockable/in-hospital cardiac arrest
• Exclusions: severe sepsis, pre-existing medical coagulopathy
• Start as soon as possible and continue for 24 h
• Rewarm slowly 0.25oC h-1
![Page 22: Post Resuscitation Care. To understand: The need for continued resuscitation after return of spontaneous circulation How to treat the post cardiac arrest.](https://reader035.fdocuments.us/reader035/viewer/2022062409/5697bfa81a28abf838c9960e/html5/thumbnails/22.jpg)
Therapeutic hypothermiaHow to cool?
• Induction - 30 ml kg-1 4oC IV fluid and/or external cooling
• Maintenance - external cooling:• Ice packs, wet towels• Cooling blankets or pads• Water circulating gel-coated pads
• Maintenance - internal cooling• Intravascular heat exchanger• Cardiopulmonary bypass
![Page 23: Post Resuscitation Care. To understand: The need for continued resuscitation after return of spontaneous circulation How to treat the post cardiac arrest.](https://reader035.fdocuments.us/reader035/viewer/2022062409/5697bfa81a28abf838c9960e/html5/thumbnails/23.jpg)
Therapeutic hypothermiaPhysiological effects and complications
• Shivering: sedate +/- neuromuscular blocking drug
• Bradycardia and cardiovascular instability• Infection• Hyperglycaemia• Electrolyte abnormalities• Increased amylase values• Reduced clearance of drugs
![Page 24: Post Resuscitation Care. To understand: The need for continued resuscitation after return of spontaneous circulation How to treat the post cardiac arrest.](https://reader035.fdocuments.us/reader035/viewer/2022062409/5697bfa81a28abf838c9960e/html5/thumbnails/24.jpg)
Assessment of prognosis
• No clinical neurological signs can predict outcome < 24 h after ROSC
• Poor outcome predicted at 3 days by:• Absent pupil light and corneal reflexes• Absent or extensor motor response to pain
• But limited data on reliability of these criteria after therapeutic hypothermia
![Page 25: Post Resuscitation Care. To understand: The need for continued resuscitation after return of spontaneous circulation How to treat the post cardiac arrest.](https://reader035.fdocuments.us/reader035/viewer/2022062409/5697bfa81a28abf838c9960e/html5/thumbnails/25.jpg)
Organ donation
• Non-surviving post cardiac arrest patient may be a suitable donor:
• Heart-beating donor (brainstem death)
• Non-heart-beating donor
![Page 26: Post Resuscitation Care. To understand: The need for continued resuscitation after return of spontaneous circulation How to treat the post cardiac arrest.](https://reader035.fdocuments.us/reader035/viewer/2022062409/5697bfa81a28abf838c9960e/html5/thumbnails/26.jpg)
Any questions?
![Page 27: Post Resuscitation Care. To understand: The need for continued resuscitation after return of spontaneous circulation How to treat the post cardiac arrest.](https://reader035.fdocuments.us/reader035/viewer/2022062409/5697bfa81a28abf838c9960e/html5/thumbnails/27.jpg)
• Post cardiac arrest syndrome is complex
• Quality of post resuscitation care influences final outcome
• Appropriate monitoring, safe transfer and continued organ support
• Assessment of prognosis is difficult
Summary
![Page 28: Post Resuscitation Care. To understand: The need for continued resuscitation after return of spontaneous circulation How to treat the post cardiac arrest.](https://reader035.fdocuments.us/reader035/viewer/2022062409/5697bfa81a28abf838c9960e/html5/thumbnails/28.jpg)
Advanced Life Support Course Slide set
All rights reserved©Australian Resuscitation Council and Resuscitation Council (UK) 2010