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Post Resuscitation Care Mike McEvoy Tim Phalen
Post Resuscitation Care
Mike McEvoyTim Phalen
Post Resuscitation Care• Rearrest is common post-ROSC
–Return Of Spontaneous Circulation–More than 50% of patients rearrest
• Early deaths are due to hemodynamic instability
• Later deaths result from–Multi-organ failure–Brain injury
AHA Lists 3 Goals for EMS1. Optimize cardiopulmonary
function and perfusion2. Transport to an appropriate
hospital (including PCI)3. Identify & treat causes; prevent
rearrest
Peberdy M et al. Circulation 2010;122:S768-S786
Post-arrest Algorithm
Post-arrest Algorithm
Post-arrest Algorithm
Post-arrest Algorithm
PA State ALS Protocol 3080
PA State ALS Protocol 3080
• Blood Pressure• EtCO2
• SpO2
• 12 lead
STAT
PA State ALS Protocol 3080
• Blood Pressure: SBP > 100 (MAP > 65)
• EtCO2: 35 – 45
• SpO2: 94 – 98%
• 12 lead: STEMI?
PA State ALS Protocol 3080
EtCO2 and SpO2
ACS (Acute Coronary Syndrome)• O2 shows little benefit, may harm• No analgesic effect• Harm study needed since 1976• Dangers:
–O2 = myocardial ischemia (Nicholson, 2004)
–Triples mortality (Rawles, 1976)
– Increases infarct size (Ukholkina, 2005)
• No benefit when sats >90%Cabello JB, Burls A, Emparanza JI, Bayliss S, Quinn T. Oxygen therapy for acute myocardial infarction (Review). The Cochrane Collection, 2010, Issue 6.
ACS: How O2 CAN Harm
Healthy volunteers, 100% O2 for 5 minutes:• coronary resistance ~ 40%• coronary blood flow (CBF) ~ 30%• Blunted CBF response to Ach (vasodilators)• Marked NO (nitric oxide, the body’s dilator)
McNulty PH, et al. Effects of supplemental oxygen administration on coronary blood flow in patients undergoing cardiac catheterization. Am J Physiol Heart Circ Physiol. 2005; 288: H1057-H1062.
CBF (Coronary Blood Flow)
Right Heart Cath:
McNulty PH, et al. Effects of supplemental oxygen administration on coronary blood flow in patients undergoing cardiac catheterization. Am J Physiol Heart Circ Physiol. 2005; 288: H1057-H1062.
PA State ALS Protocol 3080
PA State ALS Protocol 3080
STEMI?
• Appropriate destination
Prevent Rearrest
Questions?Thanks for your attention!
