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
#ROSC #PostArrest #algorithm #aha2020 #management
Cardiac Arrest - Guidelines for Crises in Anaesthesia
The probable cause is one or more of: something related to surgery or anaesthesia; the patient’s underlying medical condition; the reason for surgery; equipment failure. The first priority is to start chest compressions, then get help, then find and treat the cause using the guideline.
❶ IMMEDIATE ACTION
• Declare “cardiac arrest” to the theatre team AND note time.
• Delegate one person (minimum) to chest compressions 100 min-1, depth 5 cm.
• Call for help: nearby theatres / emergency bell / senior on-call / dial emergency number.
• Call for cardiac arrest trolley.
• As soon as possible, delegate task of evaluating potential causes (Box A).
❷ Adequate oxygen delivery
• Increase fresh gas flow, give 100% oxygen AND check measured FiO2.
• Turn off anaesthetic (inhalational or intravenous).
• Check breathing system valves working and system connections intact.
• Rapidly confirm ventilator bellows moving or provide manual ventilation.
❸ Airway
• Check position of airway device and listen for noise (including larynx and stomach).
• Confirm airway device is patent (consider passing suction catheter).
• If expired CO2 is absent, presume oesophageal intubation until absolutely excluded.
❹ Breathing
• Check chest symmetry, rate, breath sounds, SpO2, measured expired volume, ETCO2.
• Evaluate the airway pressure using reservoir bag and APL valve.
❺ Circulation
• Check rate and adequacy of chest compressions (visual and ETCO2).
• Encourage rotation of personnel performing compressions.
• If i.v. access fails or impossible use intraosseous (IO) route.
• Check ECG rhythm for no more than 5 seconds.
• Follow Resuscitation Council (UK) and ERC Guidelines.
• See Boxes B and C for reminders about drugs and defibrillation.
❻ Systematically evaluate potential underlying problems and act accordingly (Box A).
❼ If there is return of spontaneous circulation, re-establish anaesthesia.
POTENTIAL CAUSES
4 H’s, 4 T’s:
Hypoxia (→ 2-2)
Hypovolaemia
Hypo/hyperkalaemia
Hypothermia
Tamponade (→ 3-9)
Thrombosis (→3-5)
Toxins
Tension pneumothorax
Specific peri-operative problems:
Vagal tone
Drug error
Local anaesthetic toxicity (→ 3-10)
Acidosis
Anaphylaxis (→ 3-1)
Embolism, gas/fat/amniotic (→ 3-5)
Massive blood loss (→ 3-2)
By Association of Anaesthetists @ https://twitter.com/AAGBI
Quick Reference Handbook - Guidelines for crises in anaesthesia
#CardiacArrest #Checklist #Differential #Anesthesiology #Anesthesia #Intraoperative #Checklist #Diagnosis #Management #Workup
Adult ACLS - Cardiac Arrest Algorithm - AHA 2020
CPR Quality:
• Push hard (at least 2 inches [5 cm]) and fast (100-120/min) and allow complete chest recoil.
• Minimize interruptions in compressions.
• Avoid excessive ventilation.
• Change compressor every 2 minutes. or sooner if fatigued.
• If no advanced airway. 30:2 compression-ventilation ratio.
• Quantitative waveform capnography - If PETCO2 is low or decreasing, reassess CPR quality.
Shock Energy for Defibrillation:
• Biphasic: Manufacturer recommendation (eg. initial dose of 120-200 J); if unknown, use maximum available. Second and subsequent doses should be equivalent. and higher doses may be considered.
• Monophasic: 360 J
Drug Therapy:
• Epinephrine IV/IO dose: 1 mg every 3-5 minutes
• Amiodarone IV/IO dose: First dose: 300 mg bolus, Second dose: 150 mg OR
• Lidocaine IVIIO dose: First dose: 1-1.5 mg/kg, Second dose: 0.5-0.75 mg/kg.
Advanced Airway:
• Endotracheal intubation or supraglottic advanced airway
• Waveform capnography or capnometry to confirm and monitor ET tube placement
• Once advanced airway in place, give 1 breath every 6 seconds (10 breaths/min) with continuous chest compressions
Return of Spontaneous Circulation (ROSC):
• Pulse and pressure
• Abrupt sustained increase in PETCO2 (typically 240 mm Hg)
• Spontaneous arterial pressure waves with intra-arterial
Reversible Causes:
• Hypovolemia, Hypoxia, Hydrogen ion (acidosis), Hypo/hyper-kalemia, Hypothermia
• Tension pneumothorax, Tamponade (cardiac), Toxins, Thrombosis, (pulmonary), Thrombosis (coronary)
#ACLS #lifesupport #cardiacarrest #Algorithm #AHA2020 #management #adult
Adult Cardiac Arrest - ACLS Circular Algorithm - AHA 2020
CPR Quality:
• Push hard (at least 2 inches [5 cm]) and fast (100-120/min) and allow complete chest recoil.
• Minimize interruptions in compressions.
• Avoid excessive ventilation.
• Change compressor every 2 minutes. or sooner if fatigued.
• If no advanced airway. 30:2 compression-ventilation ratio.
• Quantitative waveform capnography - If PETCO2 is low or decreasing, reassess CPR quality.
Shock Energy for Defibrillation:
• Biphasic: Manufacturer recommendation (eg. initial dose of 120-200 J); if unknown, use maximum available. Second and subsequent doses should be equivalent. and higher doses may be considered.
• Monophasic: 360 J
Drug Therapy:
• Epinephrine IV/IO dose: 1 mg every 3-5 minutes
• Amiodarone IV/IO dose: First dose: 300 mg bolus, Second dose: 150 mg OR
• Lidocaine IVIIO dose: First dose: 1-1.5 mg/kg, Second dose: 0.5-0.75 mg/kg.
Advanced Airway:
• Endotracheal intubation or supraglottic advanced airway
• Waveform capnography or capnometry to confirm and monitor ET tube placement
• Once advanced airway in place, give 1 breath every 6 seconds (10 breaths/min) with continuous chest compressions
Return of Spontaneous Circulation (ROSC):
• Pulse and pressure
• Abrupt sustained increase in PETCO2 (typically 240 mm Hg)
• Spontaneous arterial pressure waves with intra-arterial
Reversible Causes:
• Hypovolemia, Hypoxia, Hydrogen ion (acidosis), Hypo/hyper-kalemia, Hypothermia
• Tension pneumothorax, Tamponade (cardiac), Toxins, Thrombosis, (pulmonary), Thrombosis (coronary)
#circular #ACLS #lifesupport #cardiacarrest #Algorithm #AHA2020 #management #adult
