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Andrianto
Ruthvi Adriana
Scenario
45 y.o man admitted to the ER
Chief complaint : ischemic chest pain since an
hour ago, ST elevation in ECG.
Immediately
unconscious
with
ventricle
Patient is ROSC
Whats happen?
To correct
Myocardial dysfunction
To manage
Systemic ischemia reperfusion response
Not only
Return of Spontaneous Circulation (ROSC)
but
Return to Pre Arrest Status
To correct
myocardial dysfunction
To manage
systemic ischemia reperfusion response
Management
ROSC
Ashvarya Mangla et al. 2014. Post-resuscitation care for survivors of cardiac arrest. Indian Heart Journal 66 (2014) S105-S112.
Patient comatose
Therapeutic
hypothermia
Ashvarya Mangla et al. 2014. Post-resuscitation care for survivors of cardiac arrest. Indian Heart Journal 66 (2014) S105-S112.
Ashvarya Mangla et al. 2014. Post-resuscitation care for survivors of cardiac arrest. Indian Heart Journal 66 (2014) S105-S112.
Ventilation
Maintain good airway
Adequate oxygenation and ventilation
Intubation if needed
Avoid hypo-hyperventilation
Reduce FIO2 as tolerated SPO2 94%
PaCO2 4045 mm hg
Ashvarya Mangla et al. 2014. Post-resuscitation care for survivors of cardiac arrest. Indian Heart Journal 66 (2014) S105-S112.
Ashvarya Mangla et al. 2014. Post-resuscitation care for survivors of cardiac arrest. Indian Heart Journal 66 (2014) S105-S112.
Ashvarya Mangla et al. 2014. Post-resuscitation care for survivors of cardiac arrest. Indian Heart Journal 66 (2014) S105-S112.
Ashvarya Mangla et al. 2014. Post-resuscitation care for survivors of cardiac arrest. Indian Heart Journal 66 (2014) S105-S112.
Metabolic
Frequent electrolyte monitoring
Treat hypo-hyperkalemia
Ashvarya Mangla et al. 2014. Post-resuscitation care for survivors of cardiac arrest. Indian Heart Journal 66 (2014) S105-S112.
Ashvarya Mangla et al. 2014. Post-resuscitation care for survivors of cardiac arrest. Indian Heart Journal 66 (2014) S105-S112.
Neurological
Baseline neurological examination
Imaging of brain to assess for ischemia / haemorrhage
if clinically indicated
Ashvarya Mangla et al. 2014. Post-resuscitation care for survivors of cardiac arrest. Indian Heart Journal 66 (2014) S105-S112.
Comatose survivors
Asystole or VF
40
% 30
20
10
31-32C
Favorable neurologic
recovery
(3 hours to 8 days)
Hypothermia (n=12)
Water-filled blanket
Normothermia (n=7)
Hypothermia
Normothermia
Cooling Technique
Cooling technique
Percentage of respondents
0%
Cooling blankets
Ice / cold liquid packing
Ice / cold liquid gastric lavage
IV cooling catheter
Cooling mist
Other method
10%
20%
30%
40%
50%
50%
15%
13%
2%
2%
17%
Coolong Blankets
Monitoring:
Seizure, shivering
Aritmia & unstable hemodinamic rewarmed
Electrolyte imbalance (Mg,K,P,Ca,Na )
Temperature check, skin care
Bleeding , dehydration, infection
Prognostication
Pre-Arrest
Arrest
Post - arrest
o Age
o Clinical examination
o Comorbidities
o Prolonged CPR
o EEG
o Initial Rhythm
o Somatosensory
o CPR quality
evoked potential
o Neurological
biochemical marker
Summary
The rate of ROSC continues to increase and proper postresuscitation care could reduce mortality and morbidity.
Strong evidence that hypothermia theraupetic is neuroprotective after return of spontaneous circulation
CARDIOVASCULAR EMERGENCIES COURSE
Thank You
Normothermia
72/136 (53%)
50/137 (36%)
Bernard
21/43 (49%)
9/34 (26%)
Hachimi-Idrissi
4/16 (25%)
1/17 (6%)
Hypothermia
Normothermia
72/136 (52%)
50/137 (36%)