Post-Cardiac Arrest Syndrome Flashcards
(23 cards)
When does reperfusion injury occur?
Complete loss of blood flow followed by abrupt ROSC
Ischemia and reperfusion bring about these 3 mechanisms that result to blood vessel instability, cell death, and brain swelling
- ROS
- Inflammatory casades
- Mitochondrial dysfunction
Cytochrome C, Oxygen free radicals, IL-6, TNF a
Common and dangerous effect of post resuscitation syndrome
Cerebral edema
Other ogran system effects: Myocardial stunning, Adrenal insufficiency
Most common cause of sudden cardiac arrest
Myocardial ischemia
Remarks on neuro examination post resuscitation
Bedside neurologic examination should not influence decisions for continued care in the first 72 hours following resuscitation
Targeted Temperature Management Goal Temperature
32-36C (89.6-96.8F)
33-36C
Range from diff sources: 33-36C; 32-34C
Application for 24 hours improves survival and neurological outcomes
Inclusion criteria for Postarrest TTM (4)
- Postresuscitation ROSC and GCS <6
- No other reason for coma
- No DNR or DNI
- Adult >17
Exclusion criteria (6)
- Awake/alert after cardiac arrest
- Arrest of traumatic etiology
- Arrest associated with significant bleeding
- Coma or vegetative state prior to arrest
- Pregnancy
- DNR/DNI
Not an exclusion crieteria: Warfarin/heparin use, initial arrest rhythm was nonshockable, Long Qt syndrome
3 Phases of TTM
- Cooling
- Maintenance
- Rewarming
These are done during the cooling phase of TTM
- Placement of central lines/arterial lines
- Sedation/paralytic treatment
- EEG/Neurologic monitoring
- Concern for shivering
Concern for hypotension is present in this phase of TTM
Rewarming
Methods of cooling in TTM (4)
- Surface wrap
- Catheter based cooling
- Chilled saline/Ice packs to axilla or groin
- Intravascular cooling (IV 30ml/kg NS at 4C over 30 mins)
Continuous monitoring including ECG and esp core temp monitoring
Do not let core temp drop to <32C; avoid fever
Duration of Hypotermia and rewarming in TTM
12 to 24 hours
Monitor MAP >60 mmHg
Too rapid rewarming = hypotenstion from vasodilation
Initiate cooling within 4-6 hrs post ROSC
Electrolyte imbalance to watch out for in TTM
HYPOKALEMIA
can result from cold-mediated diuresis
check q4
More Common Complications of TTM (6)
- Bradycarida (<50)
- Qt prolongation
- Coagulopathy (Inc PTT)
- HYPOkalemia during cooling
- HYPERkalemia during rewarming
- Shivering
Less Common Complications of TTM (3)
- Nonsustained Vtach
- Significant bleeding
- Skin injury/ulceration from cooling
Special considerations of TTM in Children
Careful avoidance of post arrest fever
T or F
Prehospital induction of TTM is approved
False
the most definitive treatment approach to shivering
neuromuscular blockade
(shivering can impede the lowering of body temperature)
Cerebral edema and increased ICP can cause cerebral herniation and serve as the cause of death, often in the initial _____ hours following resuscitation
72
Myocardial stunning is clinically evident on echocardiography as
global hypokinesis and markedly reduced EF
Myocardial depression is usually transient and typically resolves over the first few days
post-ROSC glycemic goal
100-180 mg/dL
Many postarrest patients should be considered for prompt coronary catheterization given the likelihood of coronary occlusion, especially in the setting of
ventricular fibrillation arrest in patients with coronary risk factors
(TTM started in the ED can be continued safely in the catheterization laboratory without untoward effects)
