Post Cardiac Arrest
Hypoxic encephalopathy

Out-of-Hospital Cardiac Arrest (OHCA) vs In-Hospital Cardiac Arrest (IHCA)
received _ rounds of CPR with ROSC achieved after minutes

-- Hx:
-- PE:
-- W/U: CBC,CMP.INR, aPPT, UDS, ECG, CXR, ECHO, CTH, CTA head and neck f(if focal neurologic signs), CTPA if (RV strain, hypoxic), CT a/p if (elevated lactate, hemorrhage )
-- MEDS:
-- DDX: Cardiac arrest causes = Hs & Ts: hypoxia, hypovolemia, acidosis, hypo/hyperkalemia, hypothermia, tension pneumothorax, tamponade, toxins, thrombosis (MI/PE), trauma.
-- MD PATC – DDX for coma/AMS post-arrest- Metabolic causes, Drugs/toxins, Post-anoxic brain injury, Acute neurologic events (stroke/seizure), Trauma, Cardiac causes (low perfusion), and Hypoxia.

Plan

  • Neuroprotection with TTM for Comatose/unresponsive/Altered, Maintain 32–36°C for 24h followed by 8 hours of rewarming to 37°C and temperature maintenance below 37.5°C until 72 hours

    • Contraindications to TTM= Awake, following commands, Active, uncontrolled bleeding (Cooling worsens coagulopathy ICH? Spinal bleeding? Severe coagulopathy?

  • Neurology consult for continuous cEEG within 12–24 hour for Comatose/unresponsive for 72-120 hours hrs if remains comatose

  • Maintenance of MAP > 65 with inptrops and vasopressors

  • Check electrolytes and replete q6h during cooling phase can shift K⁺, Mg²⁺, PO₄³⁻

  • Lactate and **ABGs q6h

  • Troponin q6h until peak

  • follow up with STAT echo

  • daily CBC, BMP, Mag

  • keep Glucose 140 – 180 SSI on MAR

  • keep PaCO2 40-45 (higher PaCo2 prevents cerebral vasoconstriction), target O2 sats greater than 94%, if needed consider Mechanical ventilation to maintain this

  • if STEMI or new LBBB must go to PCI

Initial labs STAT: CBC, CMP, Mg, Phos, ABG/VBG + lactate, PT/INR, aPTT, troponin, UDS ± ethanol, type & screen

Trend labs: lactate + ABG q6h, troponin q6h until peak, electrolytes (K/Mg/Phos) q6h during TTM, daily CBC/BMP/Mg

☐ ECG STAT
☐ CXR
☐ CT head (non-contrast)
☐ CTA head/neck if focal deficit or unclear cause
☐ CTPA if PE concern (RV strain, hypoxia)
☐ CT A/P if unexplained shock, ↑ lactate, or bleeding concern

☐ STAT bedside echo (POCUS/TTE)
☐ Activate cath lab if STEMI or new LBBB

☐ Start TTM if comatose (32–36°C x24h → slow rewarm → maintain <37.5°C x72h)
☐ Avoid TTM if awake or active uncontrolled bleeding

☐ Sedation ± paralysis (prevent shivering)
☐ Start vasopressors/inotropes → MAP ≥65 (norepinephrine first line)
☐ Careful electrolyte repletion (avoid overcorrection during cooling)
☐ Glucose control 140–180 (SSI)
☐ Start antiepileptics if seizures

☐ Neurology consult
☐ Continuous EEG within 12–24h (continue 72–120h if comatose)
☐ Continuous telemetry
☐ Strict I/O monitoring

☐ Ventilator targets: PaCO₂ 40–45, O₂ sat >94% (avoid hyperoxia/hypocapnia)