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Post Resuscitation Care

Post Resuscitation Care. Mike McEvoy Tim Phalen. Post Resuscitation Care. Rearrest is common post-ROSC Return Of Spontaneous Circulation More than 50% of patients rearrest Early deaths are due to hemodynamic instability Later deaths result from Multi-organ failure Brain injury.

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Post Resuscitation Care

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  1. Post Resuscitation Care Mike McEvoy Tim Phalen

  2. Post Resuscitation Care • Rearrest is common post-ROSC • Return Of Spontaneous Circulation • More than 50% of patients rearrest • Early deaths are due to hemodynamic instability • Later deaths result from • Multi-organ failure • Brain injury

  3. AHA Lists 3 Goals for EMS • Optimize cardiopulmonary function and perfusion • Transport to an appropriate hospital (including PCI) • Identify & treat causes; prevent rearrest Peberdy M et al. Circulation 2010;122:S768-S786

  4. Post-arrest Algorithm

  5. Post-arrest Algorithm

  6. Post-arrest Algorithm

  7. Post-arrest Algorithm

  8. PA State ALS Protocol 3080

  9. PA State ALS Protocol 3080 • Blood Pressure • EtCO2 • SpO2 • 12 lead STAT

  10. PA State ALS Protocol 3080 • Blood Pressure: SBP > 100 (MAP > 65) • EtCO2: 35 – 45 • SpO2: 94 – 98% • 12 lead: STEMI?

  11. PA State ALS Protocol 3080

  12. EtCO2 and SpO2

  13. ACS (Acute Coronary Syndrome) • O2 shows little benefit, may harm • No analgesic effect • Harm study needed since 1976 • Dangers: • O2 =  myocardial ischemia (Nicholson, 2004) • Triples mortality (Rawles, 1976) • Increases infarct size (Ukholkina, 2005) • No benefit when sats >90% Cabello JB, Burls A, Emparanza JI, Bayliss S, Quinn T. Oxygen therapy for acute myocardial infarction (Review). The Cochrane Collection, 2010, Issue 6.

  14. ACS: How O2 CAN Harm Healthy volunteers, 100% O2 for 5 minutes: •  coronary resistance ~ 40% •  coronary blood flow (CBF) ~ 30% • Blunted CBF response to Ach (vasodilators) • Marked  NO (nitric oxide, the body’s dilator) McNulty PH, et al. Effects of supplemental oxygen administration on coronary blood flow in patients undergoing cardiac catheterization. Am J Physiol Heart Circ Physiol. 2005; 288: H1057-H1062.

  15. CBF (Coronary Blood Flow)

  16. Right Heart Cath: McNulty PH, et al. Effects of supplemental oxygen administration on coronary blood flow in patients undergoing cardiac catheterization. Am J Physiol Heart Circ Physiol. 2005; 288: H1057-H1062.

  17. PA State ALS Protocol 3080

  18. PA State ALS Protocol 3080

  19. STEMI? • Appropriate destination

  20. Prevent Rearrest

  21. Questions?Thanks for your attention!

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