POST-CARDIAC ARREST CARE
Inclusion Criteria: These guidelines will establish treatment priorities for patients with a return of spontaneous circulation (ROSC) following cardiac arrest. BioTel defines ROSC as the return of an organized cardiac rhythm with a palpable pulse.
- Titrate supplemental oxygen delivery to maintain a SpO2 of 94-99%.
- If ROSC occurs before EMS insertion of an advanced airway and the patient does not regain consciousness, insert an advanced airway. Any approved supraglottic airway is a suitable alternative to endotracheal intubation.
- After securing the advanced airway:
- MEDICAL Etiology: Begin assisted ventilations at no more than 10 to 12 breaths per minute. Paramedics should expect a transiently elevated ETCO2 level after achieving ROSC. Do not attempt to correct this value aggressively by over-zealous assisted ventilation or hyperventilation.
- TRAUMA Etiology: Deliver 6 to 8 breaths per minute. Do not attempt to correct an elevated ETCO2 level by over-zealous assisted ventilation or hyperventilation.
- If the patient’s systolic blood pressure is less than 90 mmHg (less than 70 mmHg for the pediatric patient):
- Medical Etiology
- Administer 20 mL/kg IV/IO fluid boluses as needed, to maintain a palpable radial pulse.
- Norepinephrine bitartrate drip 8-12 mcg/min, if no response to 1000 mL total boluses.
- Administer a single 10-20 mL/kg IV/IO fluid bolus, if the patient shows signs/symptoms of shock:
- Administer only 5-10 mL/kg if heart failure or respiratory etiology is suspected;
- BioTel must approve additional fluid bolus(es).
b. Trauma Etiology
- Administer 20 mL/kg fluid boluses as needed, to maintain a palpable radial pulse
- Administer 20 mL/kg IV/IO fluid bolus.
- Repeat twice, if needed, unless signs of volume overload (e.g. JVD, rales).
- Contact BioTel for additional boluses.
- Obtain a 12-lead ECG for medical causes of cardiac arrest. Transport patients with STEMI to a hospital capable of immediate activation of a catheterization lab.
- During transport of a patient either in cardiac arrest or after ROSC, two rescuers should be present in the back of the ambulance.
- If a patient begins to awaken with an advanced airway in place post-cardiac arrest, consider sedation if coughing, gagging, or movement might lead to inadvertent extubation.
- Endotracheal tubes:
- Diazepam 2.5 – 5 mg IV/IO/IN/IM; OR
- Midazolam 2.5 – 5 mg IV/IO/IN/IM.
- May repeat once.
- Contact BioTel if the patient requires additional doses.
Do NOT initiate cooling if the patient
Is younger than 18 years old
Regains consciousness with a GCS equal to or greater than 9
Suffered cardiac arrest as the result of trauma, including burns and/or electrocution
Was hypothermic (less than 34° C or 93° F) when EMS arrived on the scene
Has evidence of florid pulmonary edema and/or volume overloa
For additional patient care considerations not covered under standing orders, consult BioTel.