Neuroprotection following Cardiac Arrest - Guidelines for Crises in Anaesthesia Outcome from cardiac arrest is determined by the severity of any supervening neurological or cardiac dysfunction / instability which results from poor vital organ perfusion. Following return of spontaneous circulation (ROSC), inability of the patient to obey commands indicates that neuroprotection techniques should be considered. ❶ Prepare the cardiac arrest trolley for any further events. ❷ Use positive pressure ventilation, aiming for: • SpO2 > 94% and < 98%. • PCO2 > 4.5 kPa and < 5.5 kPa. ❸ Give sedation and neuromuscular blocking drugs to reduce thermogenesis from shivering. ❹ Insert intra-arterial blood pressure monitoring. Consider vasopressor/inotrope to maintain systolic blood pressure, target SBP > 100 mmHg. ❺ Obtain 12-lead ECG and discuss with cardiology if percutaneous coronary intervention is possible or appropriate. ❻ Check blood glucose. Start glycaemic control therapies if above 10 mmol.l-1 ❼ Check core temperature. Target temperature is a constant temperature in the range of 32 – 36°C (precise target determined by local policy): • Temperature usually decreases without intervention in the immediate postarrest period. • Start cooling strategies if indicated (Box A). • Avoid hyperthermia > 37.5°C. ❽ Give antiepileptic drugs if seizures develop (Box B). ❾ Plan further management in critical care area. Call for extra help as necessary. By Association of Anaesthetists @ https://twitter.com/AAGBI Quick Reference Handbook - Guidelines for crises in anaesthesia #Cooling #Neuroprotection #Cardiac #Arrest #Anesthesiology #Anesthesia #Intraoperative #Checklist #Diagnosis #Management #Workup
