Post-resuscitation Care

Question 1

What is post-cardiac arrest syndrome?

Answer 1

An inflammatory state after return of spontaneous circulation

It involves multiple organ systems and requires comprehensive management.

Question 2

What are the four main components of post-cardiac arrest syndrome?

Answer 2

• Brain injury
• Myocardial dysfunction
• Systemic ischaemia-reperfusion response
• Persistent precipitating pathology

Each component has specific clinical features and treatment protocols.

Question 3

What are the clinical features of brain injury in post-cardiac arrest syndrome?

Answer 3

• Coma
• Seizures
• Cognitive dysfunction
• Brain death
• Cortical/spinal stroke

These features indicate significant neurological impairment.

Question 4

What treatments are used for brain injury in post-cardiac arrest syndrome?

Answer 4

• Cooling methods
• Controlled oxygenation
• Antiepileptic drugs (levetiracetam or sodium valproate)
• Sedative drugs

Maintaining oxygen saturation above 94% is crucial.

Question 5

What are the clinical features of myocardial dysfunction in post-cardiac arrest syndrome?

Answer 5

• Hypotension
• Dysrhythmias

These features indicate impaired cardiac function.

Question 6

What treatments are used for myocardial dysfunction in post-cardiac arrest syndrome?

Answer 6

• Revascularisation
• IV fluids
• Antiarrhythmic drugs
• Mechanical circulatory support (e.g., LVAD, ECMO)

These interventions help restore cardiac function.

Question 7

What are the clinical features of systemic ischaemia-reperfusion response?

Answer 7

• Fever
• Hyperglycemia
• Multiorgan failure
• Tissue hypoxia
• Hypotension

This response is part of the body’s reaction after cardiac arrest.

Question 8

What treatments are used for systemic ischaemia-reperfusion response?

Answer 8

• IV fluids
• Antihypotensive drugs (aim for mean arterial blood pressure > 65 mmHg)
• Glucose control (insulin infusions)
• Antipyretic drugs
• Vasopressors (e.g., noradrenaline)

These treatments aim to stabilize the patient’s hemodynamics.

Question 9

What are the causes of persistent precipitating pathology in post-cardiac arrest syndrome?

Answer 9

• Cardiac (ACS, MI)
• Respiratory (PE, pneumonia)
• CNS
• Toxins (overdose, poisoning)
• Infective (sepsis)
• Hypovolemia (haemorrhaging)

Identifying the underlying cause is essential for targeted treatment.

Question 10

What is the treatment for persistent precipitating pathology?

Answer 10

Disease-specific interventions

Treatment depends on the identified cause of the pathology.

Question 11

What investigations are performed for neurological or respiratory causes?

Answer 11

• CT head
• CTPA/CXR

These imaging studies help identify potential causes before or after coronary angiography.

Question 12

What investigations are performed for cardiac causes?

Answer 12

• Coronary angiography
• CTPA and CT head
• ECG
• Echocardiogram

These tests assess cardiac function and structure.

Question 13

What investigations are performed when the cause is unclear?

Answer 13

• CT head
• CT chest/abdomen/pelvis

These imaging modalities provide a broader assessment of potential issues.

Question 14

What lab tests are important in the management of post-cardiac arrest syndrome?

Answer 14

• FBC
• Electrolytes (Calcium, magnesium, phosphate)
• Blood cultures
• Lactate
• Troponin

These tests help evaluate metabolic and organ function.