Adult Post–Cardiac Arrest Care Algorithm - AHA2020
Initial Stabilization Phase - Resuscitation is ongoing during the post-ROSC phase, and many of these activities can occur concurrently. However, if prioritization is necessary, follow these steps:
• Airway management: Waveform capnography or capnometry to confirm and monitor endotracheal tube placement
• Manage respiratory parameters: Titrate FiO2 for SpO2 start at 10 breaths/min; titrate to PaCO2 of 35-45 mm Hg
• Manage hemodynamic parameters: Administer crystalloid and/or vasopressor or inotrope for goal systolic blood pressure >90 mm Hg or mean arterial pressure >65 mm Hg
Continued Management and Additional Emergent Activities - These evaluations should be done concurrently so that decisions on targeted temperature management (TTM) receive high priority as cardiac interventions.
• Emergent cardiac intervention: Early evaluation of 12-lead electrocardiogram (ECG); consider hemodynamics for decision on cardiac intervention
• TTM: If patient is not following commands, start TTM as soon as possible; begin at 32-36°C for 24 hours by using a cooling device with feedback loop
• Other critical care management
- Continuously monitor core temperature (esophageal, rectal, bladder)
- Maintain normoxia, normocapnia, euglycemia
- Provide continuous or intermittent electroencephalogram (EEG) monitoring
- Provide lung-protective ventilation
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