Post Arrest Care in the Ambulance Enviroment

This is a short podcast, on the current position of prehospital care in Post Arrest patient, produced as part of my post graduate work.

As always the podcast can be found in the I Tunes feed, or streamed via podomatic.

https://itunes.apple.com/au/podcast/downstairs-care-outthere-podcast/id876296199

402 Podcast Reference Note:

Begin with introduction (Identify time, date, location and person recording)
Case Study for OHCA with ROSC, Setting the scene for beginning of podcast.
Review review reversible causes of Cardiac Arrest to review whats caused and what will be the guide to post arrest care
Review Airway interventions, ETT has been deemphasised if SGA is in situ.
Post arrest patients may need sedation, if they have spontaneous changes in LOC that may cause them to become agitated and regain purposeful movement.
Attention needs to be paid to the rate and volume of ventilation, ideal is 98% to 94% SPO2 post arrest
Post arrest capnography is standard of care for intubated patients.
Support patients cardiac output with fluids and Adrenaline infusion.
Attempt to move patient to a Percutaneous Coronary Intervention Capable hospital or Service capable of Thrombolysis.
If your service is capable of providing Prehospital Thombolysis this can be performed if indicated. Evidence shows that thrombolysis can be safely performed post arrest.
Close off patient case study from beginning of podcast.

402 Podcast Reference List;

Deasy, C., Bernard, S., Cameron, P., Jacobs, I., Smith, K., Hein, C., . . . Finn, J. (2011). Design of the RINSE Trial: The Rapid Infusion of cold Normal Saline by paramedics during CPR. BMC Emerg Med, 11, 17-17. doi: 10.1186/1471-227X-11-17

Dumas, F., Cariou, A., Manzo-Silberman, S., Grimaldi, D., Vivien, B., Rosencher, J., . . . Spaulding, C. (2010). Immediate Percutaneous Coronary Intervention Is Associated With Better Survival After Out-of-Hospital Cardiac Arrest: Insights From the PROCAT (Parisian Region Out of Hospital Cardiac Arrest) Registry. Circulation: Cardiovascular Interventions, 3(3), 200-207. doi: 10.1161/circinterventions.109.913665

Kern, K. B. (2012). Optimal Treatment of Patients Surviving Out-of-Hospital Cardiac Arrest. JACC: Cardiovascular Interventions, 5(6), 597-605. doi: 10.1016/j.jcin.2012.01.017
Kilgannon, J., Jones, A. E., Shapiro, N. I., & et al. (2010). ASsociation between arterial hyperoxia following resuscitation from cardiac arrest and in-hospital mortality. JAMA, 303(21), 2165-2171. doi: 10.1001/jama.2010.707

Neumar, R. W., Nolan, J. P., Adrie, C., Aibiki, M., Berg, R. A., Böttiger, B. W., . . . Vanden Hoek, T. (2008). Post–Cardiac Arrest Syndrome: Epidemiology, Pathophysiology, Treatment, and Prognostication A Consensus Statement From the International Liaison Committee on Resuscitation (American Heart Association, Australian and New Zealand Council on Resuscitation, European Resuscitation Council, Heart and Stroke Foundation of Canada, InterAmerican Heart Foundation, Resuscitation Council of Asia, and the Resuscitation Council of Southern Africa); the American Heart Association Emergency Cardiovascular Care Committee; the Council on Cardiovascular Surgery and Anesthesia; the Council on Cardiopulmonary, Perioperative, and Critical Care; the Council on Clinical Cardiology; and the Stroke Council. Circulation, 118(23), 2452-2483. doi:

10.1161/circulationaha.108.190652

Nielsen, N., Wetterslev, J., Cronberg, T., Erlinge, D., Gasche, Y., Hassager, C., . . . Friberg, H. (2013). Targeted Temperature Management at 33°C versus 36°C after Cardiac Arrest. New England Journal of Medicine, 369(23), 2197-2206. doi: doi:10.1056/NEJMoa1310519

Spöhr, F., & Böttiger, B. (2003). Safety of Thrombolysis during Cardiopulmonary Resuscitation. Drug Safety, 26(6), 367-379. doi: 10.2165/00002018-200326060-00001
Sunde, K., Pytte, M., Jacobsen, D., Mangschau, A., Jensen, L. P., Smedsrud, C., . . . Steen, P. A. (2007). Implementation of a standardised treatment protocol for post resuscitation care after out-of- hospital cardiac arrest. Resuscitation, 73(1), 29-39. doi: 10.1016/j.resuscitation.2006.08.016 1