Page 281 - PJ MED OPS Handbook 8th Ed

Adult ACLS Post Cardiac Arrest Care
ACLS Healthcare Provider
Post–Cardiac Arrest Care Algorithm

ROSC obtained Initial Stabilization Phase
Resuscitation is ongoing during the
post-ROSC phase, and many of these
Manage airway activities can occur concurrently.
Early placement of endotracheal tube However, if prioritization is
necessary, follow these steps:
• Airway management:
Manage respiratory parameters
Initial Start 10 breaths/min Waveform capnography or
capnometry to confirm and monitor
Stabilization Spo 2 92%-98%
endotracheal tube placement
Phase Paco 2 35-45 mm Hg
• Manage respiratory parameters:
Titrate Fio 2 for Spo 2 92%-98%; start
Manage hemodynamic parameters at 10 breaths/min; titrate to Paco 2 of
Systolic blood pressure >90 mm Hg 35-45 mm Hg
Mean arterial pressure >65 mm Hg
• Manage hemodynamic parameters:
Administer crystalloid and/or
vasopressor or inotrope for goal
systolic blood pressure >90 mm Hg
Obtain 12-lead ECG
or mean arterial pressure >65 mm Hg
Continued Management and
Consider for emergent cardiac intervention if Additional Emergent Activities
• STEMI present
These evaluations should be done
• Unstable cardiogenic shock
concurrently so that decisions on
• Mechanical circulatory support required
targeted temperature management
(TTM) receive high priority as
cardiac interventions.
• Emergent cardiac intervention:
Follows commands?
Early evaluation of 12-lead
No Yes
Continued electrocardiogram (ECG); consider
Management hemodynamics for decision on
and Additional Comatose Awake cardiac intervention
Emergent • TTM Other critical care • TTM: If patient is not following
Activities • Obtain brain CT management commands, start TTM as soon as
• EEG monitoring possible; begin at 32-36°C for 24
• Other critical care hours by using a cooling device with
management feedback loop
• Other critical care management
– Continuously monitor core
temperature (esophageal,
rectal, bladder)
Evaluate and treat rapidly reversible etiologies
– Maintain normoxia, normocapnia,
Involve expert consultation for continued management
euglycemia
– Provide continuous or intermittent
electroencephalogram (EEG)
monitoring
– Provide lung-protective ventilation
H’s and T’s
Hypovolemia
Hypoxia
Hydrogen ion (acidosis)
Hypokalemia/hyperkalemia
Hypothermia
Tension pneumothorax
Tamponade, cardiac
Toxins
Thrombosis, pulmonary
Thrombosis, coronary
© 2020 American Heart Association
Appendix 2: Emergency Cardiovascular Care n 279