Oxygenation and ventilation | |
Measure oxygenation and target normoxemia 94 to 99% (or child's normal/appropriate oxygen saturation). | |
Avoid hypoxemia. | |
Measure PaCO2 and target a clinically appropriate value. | |
Avoid hypocapnia. | |
Hemodynamic monitoring | |
Set specific hemodynamic goals during PCAC and review daily. | |
Use cardiac telemetry. | |
Monitor arterial blood pressure. | |
Monitor serum lactate, urine output, and central venous oxygen saturation to help guide therapies. | |
Use parenteral fluid bolus with or without inotropes or vasopressors to maintain a systolic blood pressure greater than the fifth percentile for age and sex. | |
TTM | |
Measure and monitor continuous core temperature. | |
Prevent and promptly treat fever. | |
Apply TTM (32°C to 34°C) for 48 hours and then maintain TTM (36°C to 37.5°C) for 3 days after rewarming, or apply TTM (36°C to 37.5°C) for 5 days if patient is unresponsive after ROSC. | |
Prevent shivering. | |
Monitor blood pressure and treat hypotension during rewarming. | |
Prevent fever after rewarming. | |
Neuromonitoring | |
Treat clinical seizures. | |
Ensure no routine use of pharmacological prophylaxis for seizures. | |
Consider early brain imaging to diagnose treatable causes of cardiac arrest. | |
Glucose control | |
Measure blood glucose. | |
Avoid hypoglycemia. | |
Sedation | |
Treat with sedatives and anxiolytics. | |
Prognosis | |
Always consider multiple modalities (clinical and other) over any single predictive factor. | |
EEG in conjunction with other factors may be useful within the first 7 days of PCAS. | |
Neuroimaging such as MRI during the first 7 days may be valuable. | |
Remember that assessments may be modified by TTM or induced hypothermia. |
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