Post-cardiac arrest care starts the moment a pulse returns (return of spontaneous circulation, or ROSC) and aims to protect the brain and heart while the cause is found. The first minutes after ROSC are unstable, and the patient can lose the pulse again, drop the blood pressure or stop breathing at any time.
Key symptoms
- Return of a pulse after CPR, often with low or unstable blood pressure
- Coma or reduced response in most patients
- Absent, weak or irregular breathing
- Seizures or muscle jerks in some patients
- Signs of the original cause: chest pain, overdose, trauma or low oxygen
What you find on exam
- Recheck the pulse often and watch for rearrest
- Blood pressure, heart rate and oxygen saturation every few minutes
- Airway position and chest rise with each breath
- Level of response with the Glasgow Coma Scale and pupils
- Clues to the cause: needle marks, injuries, medical alert tags
Tests
- 12-lead ECG as soon as possible to look for STEMI
- Continuous waveform capnography, aiming for 35 to 45 mmHg
- Blood glucose check
- Hospital: troponin, electrolytes, blood gas, CT head and echocardiogram
Treatment basics
- Keep oxygen saturation 92 to 98 percent and avoid overventilation (about 10 breaths per minute)
- Treat systolic pressure below 90 mmHg with IV fluids and a norepinephrine or epinephrine infusion
- Transport to a cardiac arrest center; STEMI goes to the cath lab
- Temperature control and fever prevention in patients who stay comatose
- Treat seizures and the cause of the arrest
Red flags
- Loss of pulse or a sudden drop in end-tidal CO2
- Systolic pressure below 90 mmHg despite treatment
- ST elevation on the 12-lead ECG
Practice it in Making Synapses
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Related guides
Sources: NASEMSO National Model EMS Clinical Guidelines; AHA Guidelines for CPR and ECC; NREMT psychomotor skill sheets (EMT and Paramedic). Written by Making Synapses. Making Synapses is not affiliated with these organizations.