Post–Cardiac Arrest Care AHA 2015

1. Post–Cardiac Arrest Care AHA 2015 DrNahidZirak MUMS Imam Reza Hospital – Departement of Anesthesiology

2. Post Cardiac Arrest Care (Intruduction) Systematic care Positive correlation Early mortality Late mortality

3. Post Cardiac Arrest Care(Intruduction) proactive management of post cardiac arrest physiology Mere restoration of blood pressure and gas exchange Significant cardiovascular dysfunction Neurologic outcome Hemodynamic optimization protocols

4. Post Cardiac Arrest Care(Intruduction) Optimize the patient’s hemodynamic and ventilation status Initiate TTM Provide immediate coronary reperfusion with PCI Provide neurologic care and prognosticationand other structured interventions

5. Rhythms for Post Cardiac Arrest Care

6. Drugs for Post Cardiac Arrest Care Epinephrine Dopamine Norepinephrine

7. Multiple System Approach to Post-Cardiac Arrest Care A structured, multidisciplinary system of care : TTM Optimization of hemodynamics and gas exchange PCI Neurologic diagnosis Critical care management, and prognostication Cause of cardiac arrest after ROSC

8. Overview of Post cardiac Arrest Care Airway & breathing adequacy Unconscious :advanced airway Elevation of head waveform capnography pulse oximetry

10. Ventilation

12. Reassessment

13. Survival After Cardiac Arrest Major factors TTM for any patient who is comatose and unresponsive PCI

14. cause of cardiac arrest Cardiovascular disease 12-lead ECG Coronary angiography (awake or comatose) AMI

15. Neurologic Prognosis Earliest time : 72 hr 72 hr after return to normothermia with TTM Sedation or paralysis

16. Prognostication After Cardiac Arrest pupillary reflex to light status myoclonus N20 SSEP

17. Prognostication After Cardiac Arrest marked reduction of the gray-white ratio on brain CT obtained within 2 hours after cardiac arrest

18. absence of EEG reactivity to external stimuli at 72 hours after cardiac arrest Persistent burst suppression or intractable status epilepticus on EEG after rewarming

20. The Post-Cardiac Arrest Care Algorithm The H’s and T’s : clues and suggested treatments

21. Rhythm was organized and a pulse was detected

22. Optimize Ventilation and Oxygenation

23. Critical Concepts Waveform Capnography Tube position CPR quality Optimize chest compressions Detect ROSC

24. Caution Wath things to AvoidADuring Ventilation ? ties Excessive ventilation

26. Major determinant of CO delivery to the lung Persistent capnographic waveform Supraglottic airway

27. Capnography

28. Capnography

29. Capnography During CC

30. Capnography After ROSC

31. Treat Hypotension (SBP < 9O mm Hg) SBP is less than 90 mm Hg IV access Verify the patency of any IV lines ECG monitoring IV bolus 1-2 L normal saline or lactated Ringer's Norepinephrine 0.1—0.5 mcg/kg/min Epinephrine 0.1—0.5 mcg/kg/min Dopamine 5-10 mcg/kg/min MAP > 65 mmHg

32. STEMI is present or a high suspicion of AMI Both in- and out-of-hospital medical personnel Step 5

34. Coronary Reperfusion PCI : coma or TTM

37. Following Commands not command TTM (Step 7) follow command Move to Step 8

40. Targeted Tempreture Management TTM in who remain comatose 32°C and 36°C 24 hours Optimal method Some risk Routine cooling In the prehospitalafter ROSC with rapid infusion of cold IV fluids

42. Targeted Temperature Management Current clinical practices

43. Neurologic recovery after cardiac arrest Duration of TTM is at least 24 hours Core temperature decision to perform PCI

44. Advanced Critical Care After coronary reperfusion or no MI transfer to ICU Post-Cardiac Arrest Maintenance Therapy Prophylactic antiarrhythmic medications