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Post-Cardiac Arrest Care ACLS Algorithm - Updated 2018

The Post-Cardiac Arrest Care algorithm will take you through the implementation of a comprehensive treatment protocol for post-cardiac arrest care. This case is applicable to a patient who has had cardiac arrest and was resuscitated with the BLS, ACLS Primary, and ACLS Secondary Assessments.

Post-Cardiac Arrest Care ACLS Algorithm Download Printable Algorithm

STEP 1

Optimize Ventilation and Oxygenation

  • Consider an advanced airway if one is not in place.

  • While ventilating a post-arrest patient, begin with a rate of 10 to 12 breaths per minute.

  • Titrate oxygen to maintain an arterial oxygen saturation of 94% during the post-cardiac arrest phase, reducing the risk of oxygen toxicity.

  • Avoid excessive ventilation, which may reduce cerebral blood flow due to the decrease in the PaCO2 level.

  • Excessive ventilation also has the potential to cause high intrathoracic pressures, leading to adverse hemodynamic effects (decreased cardiac output and cerebral perfusion) during the post arrest phase.

  • Use quantitative waveform capnography to regulate and titrate ventilation rates during the post arrest phase. PETCO2 should be between 30-40 mm Hg and PaCO2 should have a range of 35-45 mm Hg.

STEP 2

Hemodynamic Support: treat hypotension (systolic blood pressure < 90 mmHg)

  • Optimization of organ perfusion is the primary goal of hemodynamic support.

  • IV or IO bolus: 1-2 L normal saline or lactated Ringer's. For therapeutic hypothermia, cool IVF to 4°C.

  • Infuse vasopressors: epinephrine, dopamine, norepinephrine

  • Epinephrine: 0.1-0.5 mcg/kg/minute IV infusion, titrate to SBP > 90 mm Hg or MAP > 65 mm Hg

  • Dopamine: 5-10 mcg/kg/min IV infusion titrated to SBP > 90 mm Hg or MAP > 65 mm Hg

  • Norepinephrine: 0.1-0.5 mcg/kg/minute IV infusion titrated to SBP > 90 mm Hg or MAP > 65 mm Hg

STEP 3

Assess The Patient: does the patient follow commands?

  • Accurate and reliable evaluation must be available to guide the return of neurologic function and to guide decisions to limit or withdraw care after an accurate prognosis of poor outcome becomes evident.

  • Providers must wait at least 72 hours after returning to normothermia to prognosticate an outcome in patients treated with therapeutic hypothermia.

STEP 4

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STEP 5

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STEP 6

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