Resuscitation from Cardiac Arrest (page 4)

Issue 10 (1999) Article 6: Page 4 of 4

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Resuscitation from Cardiac Arrest (Continued)

Post-Arrest Management

Following the restoration of a spontaneous cardiac output, the metabolic changes and the likelihood of the injured heart developing arrhythmias make further monitoring and intensive care essential. There may also be a need to provide a period of brain protection to maximise chances of recovery. To allow this, the optimum place for a recovering arrest victim is in a high dependency, coronary care or intensive care area. Even if successful resuscitation is achieved very rapidly, the heart may still be significantly damaged and is at risk of further arrhythmias.

If the patient is alert, maintaining an airway and breathing adequately, he may be extubated and admitted to a coronary care unit for monitoring and observation. Support of the cardiac output and circulation may be required with the guidance of invasive monitoring, including central venous cannulation, if available. Monitoring of end organ function, such as urine output is also required. Post cardiac arrest investigations should include serial 12-lead ECGs, CXR and basic blood tests including electrolytes, full blood count, magnesium and cardiac enzyme measurement if available. In the case of a proven myocardial infarction (ECG, enzymes) streptokinase may be considered.

If the resuscitation was prolonged, there is a significant metabolic disturbance, if the patient is cerebrally obtunded or requires a high level of inotropic support, admission to an intensive therapy unit for mechanical ventilation may be indicated, depending on the patient's prognosis and available facilities. The detailed management of post resuscitation care is beyond the scope of this article. Failure to recover consciousness 24 hours after resuscitation indicates a poor prognosis.

Special Points for Intra-Operative Arrests (to be used in conjunction with normal guidelines and treatment of the specific problem if known)

Stop all anaesthetic agents, administer 100% oxygen and ventilate the lungs.
Ask the surgical team to begin chest compressions at 5 chest compressions to 1 ventilation.
If the patient is pregnant, create at least 10-15⁰ of left lateral tilt to allow CPR to be effective
Commence ECG and end-tidal CO2 monitoring if not already in place.
Convert the airway to a tracheal tube and check its position and patency:
- Observe chest movement.
- Auscultate the chest and clinically exclude a pneumothorax.
- Observe th eend-tidal CO2 output if available.
- If in any doubt, change the tube.
Check the oxygen supply. If in doubt, change to a cylinder or air.
Check the fresh gas delivery from the ventilator to the patient. If in doubt, change to a self-inflating bag with an oxygen reservoir.
If possible, send blood for arterial blood gases (ABGs), electrolytes and calcium. Aim to repeat ABGs, acid base values and potassium every 10-15 minutes.
If the arrest is accompanied by significant hypothermia or is due to local anaesthetic toxicity, resuscitation is likely to be prolonged.

Further Reading

ABC of Resuscitation. British Medical Association UK

Advanced Life Support Course Provider Manual (3^rd edition) Resuscitation Council UK 1998.

European Resuscitation Council Guidelines for Resuscitation. European Resuscitation Council (1998). Ed. L. Bossaert. Elseviar.

Flow chart for the advanced management of the airway and ventilation.

This article contained links to the following additional information:

Oesophageal Detector Devices
Anaesthesia for the Patient with a Full Stomach
Prediction and Management of Difficult Tracheal Intubation