Post Cardiac Arrest Syndrome

Question 1

Predictors of outcomes post ROSC

Answer 1

Clinical neurologic reflexes are not predictive of cardiac arrest outcomes. Bedside neuro exams should not influence decisions for continued care in the first 72hrs following successful resuscitation

Head CT:
- can ID SAH, epi/sub hematoma, and cerebral edema

Early cerebral edema and seizures are bad signs

Question 2

Theoretical purpose of targeted temp management

Answer 2

Dramatically improve neurologic outcomes…
In a eurpoean study of VF/VT
- less evidence for PEA or asystole

Question 3

Inclusion criteria for TTM

Answer 3

Coma post ROSC w/ GCS <6 w/o other cause
Adults >17 who are not DNR, DNI

Question 4

Other than VT/VF when else might TTM help?

Answer 4

Hanging related asphyxiation arrest

Question 5

Adverse Effects of TTM

Answer 5

Cardiac:
- pronounced bradycardia - do nothing
- tachycardia, afib, NS VT - until temp <32 is reached
- QTc prolongation

Systemic:
- shivering (prevents temp goal)
- bleeding is exacerbated by low core temp
- hypo K and hypo Mag from intracellular shift and diuresis

Question 6

Cooling techinques

Answer 6

Commercial cooling systems
- surface-wrap
- catheter based

Chilled saline/ice packs to axilla and groin

Question 7

Phases of TTM

Answer 7

Induction - getting to goal of 32-36C
Maintenance - x 24hrs
Rewarming - slow (12-24hrs)